[New evidence for endovascular versus open treatment of patients with an aneurysm of the abdominal aorta].
Recent randomised trials have compared conventional and endovascular repair of asymptomatic abdominal aortic aneurysms (DREAM and EVAR I trials), and endovascular repair with no intervention in high-risk patients (EVAR 2 trial). DREAM and EVAR I showed that endovascular repair is associated with lower perioperative mortality, but overall survival is not improved after mid-term follow-up. EVAR 2 showed that high-risk patients do not benefit from elective endovascular repair. It can be concluded that relatively young and low-risk patients should be treated with open repair and that conservative treatment may be appropriate for high-risk patients. Between these extremes is a large group ofpatients who may benefit from endovascular repair. However, long-term follow-up data are not yet available and costs for endovascular therapy are substantial.
Legemate
D A
DA
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Epidemiologie, Postbus 22.660, 1100 DD Amsterdam. d.a.legemate@amc.uva.nl
D017544:Aortic Aneurysm, Abdominal / Q000191:economics / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics / Q000401:mortality; D019317:Evidence-Based Medicine; D017721:Hospital Costs; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate