title: Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.
abstract: 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.)
authors.affiliation: From the Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
authors.forename: Jorg L
authors.initials: JL
authors.lastname: De Bruin
authors.forename: Annette F
authors.initials: AF
authors.lastname: Baas
authors.forename: Jaap
authors.initials: J
authors.lastname: Buth
authors.forename: Monique
authors.initials: M
authors.lastname: Prinssen
authors.forename: Eric L G
authors.initials: EL
authors.lastname: Verhoeven
authors.forename: Philippe W M
authors.initials: PW
authors.lastname: Cuypers
authors.forename: Marc R H M
authors.initials: MR
authors.lastname: van Sambeek
authors.forename: Ron
authors.initials: R
authors.lastname: Balm
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Jan D
authors.initials: JD
authors.lastname: Blankensteijn
mesh_terms: 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