Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial.
BACKGROUND
Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair.


OBJECTIVE
To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial.


METHODS
A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008.


METHODS
Elective endovascular (n = 444) or open (n = 437) repair of AAA.


METHODS
Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality.


RESULTS
Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function.


CONCLUSIONS
In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures.


BACKGROUND
clinicaltrials.gov Identifier: NCT00094575.
Lederle
Frank A
FA
Medicine Service, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA. frank.lederle@va.gov
Freischlag
Julie A
JA
Kyriakides
Tassos C
TC
Padberg
Frank T
FT
Matsumura
Jon S
JS
Kohler
Ted R
TR
Lin
Peter H
PH
Jean-Claude
Jessie M
JM
Cikrit
Dolores F
DF
Swanson
Kathleen M
KM
Peduzzi
Peter N
PN
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D002406:Catheterization, Peripheral; D007172:Erectile Dysfunction / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D011788:Quality of Life