Impact of randomized trials comparing conventional and endovascular abdominal aortic aneurysm repair on clinical practice.
OBJECTIVE
To report a retrospective study into the effects of trials on clinical decision-making regarding abdominal aortic aneurysm (AAA) patients suitable for both conventional open (OR) and endovascular aneurysm repair (EVAR).


METHODS
A questionnaire was sent to 1400 Dutch surgeons and trainees. Interviewees had to choose between OR and EVAR for AAA patients with and without comorbidity. Specifically, their preferences before and after the publication of 2 randomized trials (EVAR-1 and DREAM) were polled.


RESULTS
Of the 524 (37%) questionnaires returned, 223 (43%) respondents treated AAA patients. Before publication of the trials, 160 (72%) preferred OR for the patient without comorbidity and 169 (76%) preferred EVAR for the patient with comorbidity. In total, 72 (32%) respondents changed their preference after the trials were published; however, there was no overall major shift. Focusing on the different cases revealed that the OR preference was significantly enhanced for the patient without comorbidity (p<0.01), while the EVAR preference was significantly enhanced for the patient with comorbidity (p<0.05).


CONCLUSIONS
The randomized trials have not induced major overall changes in surgical decision-making for AAA patients suitable for both EVAR and OR.
Baas
Annette F
AF
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. a.f.baas@umcutrecht.nl
Grobbee
Diederick E
DE
Blankensteijn
Jan D
JD
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002983:Clinical Competence; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009426:Netherlands; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome