title: Editor's Choice - ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): A French Randomized Controlled Trial of Endovascular Versus Open Surgical Repair of Ruptured Aorto-iliac Aneurysms.
abstract: OBJECTIVE
  ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus) is a prospective multicentre randomized controlled trial including consecutive patients with ruptured aorto-iliac aneurysms (rAIA) eligible for treatment by either endovascular (EVAR) or open surgical repair (OSR). Inclusion criteria were hemodynamic stability and computed tomography scan demonstrating aorto-iliac rupture.
  
  
  METHODS
  Randomization was done by week, synchronously in all centers. The primary end point was 30 day mortality. Secondary end points were post-operative morbidity, length of stay in the intensive care unit (ICU), amount of blood transfused (units) and 6 month mortality.
  
  
  RESULTS
  From January 2008 to January 2013, 107 patients (97 men, 10 women; median age 74.4 years) were enrolled in 14 centers: 56 (52.3%) in the EVAR group and 51 (47.7%) in the OSR group. The groups were similar in terms of age, sex, consciousness, systolic blood pressure, Hardman index, IGSII score, type of rupture, use of endoclamping balloon, and levels of troponin, creatinine, and hemoglobin. Delay to treatment was higher in the EVAR group (2.9 vs. 1.3 hours; p < .005). Mortality at 30 days and 1 year were not different between the groups (18% in the EVAR group vs. 24% in the OSR group at 30 days, and 30% vs. 35%, respectively, at 1 year). Total respiratory support time was lower in the EVAR group than in the OSR group (59.3 hours vs. 180.3 hours; p = .007), as were pulmonary complications (15.4% vs. 41.5%, respectively; p = .050), total blood transfusion (6.8 vs. 10.9, respectively; p = .020), and duration of ICU stay (7 days vs. 11.9 days, respectively; p = .010).
  
  
  CONCLUSIONS
  In this study, EVAR was found to be equal to OSR in terms of 30 day and 1 year mortality. However, EVAR was associated with less severe complications and less consumption of hospital resources than OSR.
authors.affiliation: Vascular Surgery Unit, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France. Electronic address: pascal.desgranges@hmn.aphp.fr.
authors.forename: P
authors.initials: P
authors.lastname: Desgranges
authors.affiliation: Radiology Unit, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France.
authors.forename: H
authors.initials: H
authors.lastname: Kobeiter
authors.affiliation: Pôle Recherche Clinique, CHU Henri Mondor, Creteil, France.
authors.forename: S
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: Vascular Surgery Unit, CHU Nord, Marseille, France.
authors.forename: M
authors.initials: M
authors.lastname: Bouffi
authors.affiliation: Vascular Surgery Unit, CHRU Brest, Brest, France.
authors.forename: P
authors.initials: P
authors.lastname: Gouny
authors.affiliation: Vascular Surgery Unit, CHU Saint-Etienne, Saint-Etienne, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Favre
authors.affiliation: Vascular Surgery Unit, CHU HEGP, Paris, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Alsac
authors.affiliation: Vascular Surgery Unit, CHRU Lille, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Sobocinski
authors.affiliation: Vascular Surgery Unit, CHU HEGP, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Julia
authors.affiliation: Vascular Surgery Unit, CHU Nord, Marseille, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Alimi
authors.affiliation: Vascular Surgery Unit, CHU Le Bocage, Dijon, France.
authors.forename: E
authors.initials: E
authors.lastname: Steinmetz
authors.affiliation: Vascular Surgery Unit, CHRU Lille, Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Haulon
authors.affiliation: Vascular Surgery Unit, CHU Montpellier, Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Alric
authors.affiliation: Vascular Surgery Unit, CHU Montpellier, Montpellier, France.
authors.forename: L
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Vascular Surgery Unit, CHU Bichat, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Castier
authors.affiliation: Vascular Surgery Unit, CHU Nice, Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: Vascular Surgery Unit, CHU Nice, Nice, France.
authors.forename: R
authors.initials: R
authors.lastname: Hassen-Khodja
authors.affiliation: Vascular Surgery Unit, CHU Lyon, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Lermusiaux
authors.affiliation: Vascular Surgery Unit, CHU Lyon, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Feugier
authors.affiliation: CHR Annecy, Annecy, France.
authors.forename: L
authors.initials: L
authors.lastname: Destrieux-Garnier
authors.affiliation: Pôle Recherche Clinique, CHU Henri Mondor, Creteil, France.
authors.forename: A
authors.initials: A
authors.lastname: Charles-Nelson
authors.affiliation: Vascular Surgery Unit, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France.
authors.forename: J
authors.initials: J
authors.lastname: Marzelle
authors.affiliation: Vascular Surgery Unit, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Majewski
authors.affiliation: ICL Hygee, Saint Priest en Jarez, France.
authors.forename: A
authors.initials: A
authors.lastname: Bourmaud
authors.affiliation: Vascular Surgery Unit, CHU Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Creteil, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Becquemin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005260:Female; D005602:France; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: AAA rupture; EVAR; Open surgical repair