Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.
BACKGROUND
For patients with large abdominal aortic aneurysms, randomized trials have shown an initial overall survival benefit for elective endovascular repair over conventional open repair. This survival difference, however, was no longer significant in the second year after the procedure. Information regarding the comparative outcome more than 2 years after surgery is important for clinical decision making.


METHODS
We conducted a long-term, multicenter, randomized, controlled trial comparing open repair with endovascular repair in 351 patients with an abdominal aortic aneurysm of at least 5 cm in diameter who were considered suitable candidates for both techniques. The primary outcomes were rates of death from any cause and reintervention. Survival was calculated with the use of Kaplan-Meier methods on an intention-to-treat basis.


RESULTS
We randomly assigned 178 patients to undergo open repair and 173 to undergo endovascular repair. Six years after randomization, the cumulative survival rates were 69.9% for open repair and 68.9% for endovascular repair (difference, 1.0 percentage point; 95% confidence interval [CI], -8.8 to 10.8; P=0.97). The cumulative rates of freedom from secondary interventions were 81.9% for open repair and 70.4% for endovascular repair (difference, 11.5 percentage points; 95% CI, 2.0 to 21.0; P=0.03).


CONCLUSIONS
Six years after randomization, endovascular and open repair of abdominal aortic aneurysm resulted in similar rates of survival. The rate of secondary interventions was significantly higher for endovascular repair. (ClinicalTrials.gov number, NCT00421330.)
De Bruin
Jorg L
JL
From the Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
Baas
Annette F
AF
Buth
Jaap
J
Prinssen
Monique
M
Verhoeven
Eric L G
EL
Cuypers
Philippe W M
PW
van Sambeek
Marc R H M
MR
Balm
Ron
R
Grobbee
Diederick E
DE
Blankensteijn
Jan D
JD
D000368:Aged; D017130:Angioplasty; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012086:Reoperation; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000401:mortality