Long-term comparison of endovascular and open repair of abdominal aortic aneurysm

Frank A. Lederle, Julie A. Freischlag, Tassos C. Kyriakides, Jon S. Matsumura, Frank T. Padberg, Ted R. Kohler, Panagiotis Kougias, Jessie M. Jean-Claude, Dolores F. Cikrit, Kathleen M. Swanson

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Whether elective endovascular repair of abdominal aortic aneurysm reduces long-term morbidity and mortality, as compared with traditional open repair, remains uncertain. METHODS: We randomly assigned 881 patients with asymptomatic abdominal aortic aneurysms who were candidates for both procedures to either endovascular repair (444) or open repair (437) and followed them for up to 9 years (mean, 5.2). Patients were selected from 42 Veterans Affairs medical centers and were 49 years of age or older at the time of registration. RESULTS: More than 95% of the patients underwent the assigned repair. For the primary outcome of all-cause mortality, 146 deaths occurred in each group (hazard ratio with endovascular repair versus open repair, 0.97; 95% confidence interval [CI], 0.77 to 1.22; P = 0.81). The previously reported reduction in perioperative mortality with endovascular repair was sustained at 2 years (hazard ratio, 0.63; 95% CI, 0.40 to 0.98; P = 0.04) and at 3 years (hazard ratio, 0.72; 95% CI, 0.51 to 1.00; P = 0.05) but not thereafter. There were 10 aneurysm-related deaths in the endovascular-repair group (2.3%) versus 16 in the open-repair group (3.7%) (P = 0.22). Six aneurysm ruptures were confirmed in the endovascular-repair group versus none in the open-repair group (P = 0.03). A significant interaction was observed between age and type of treatment (P = 0.006); survival was increased among patients under 70 years of age in the endovascular-repair group but tended to be better among those 70 years of age or older in the open-repair group. CONCLUSIONS: Endovascular repair and open repair resulted in similar long-term survival. The perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected. (Funded by the Department of Veterans Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575).

Original languageEnglish (US)
Pages (from-to)1988-1997
Number of pages10
JournalNew England Journal of Medicine
Volume367
Issue number21
DOIs
StatePublished - Nov 22 2012
Externally publishedYes

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Abdominal Aortic Aneurysm
Survival
Veterans
Confidence Intervals
Aneurysm
Mortality
Rupture
Morbidity
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lederle, F. A., Freischlag, J. A., Kyriakides, T. C., Matsumura, J. S., Padberg, F. T., Kohler, T. R., ... Swanson, K. M. (2012). Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. New England Journal of Medicine, 367(21), 1988-1997. https://doi.org/10.1056/NEJMoa1207481

Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. / Lederle, Frank A.; Freischlag, Julie A.; Kyriakides, Tassos C.; Matsumura, Jon S.; Padberg, Frank T.; Kohler, Ted R.; Kougias, Panagiotis; Jean-Claude, Jessie M.; Cikrit, Dolores F.; Swanson, Kathleen M.

In: New England Journal of Medicine, Vol. 367, No. 21, 22.11.2012, p. 1988-1997.

Research output: Contribution to journalArticle

Lederle, FA, Freischlag, JA, Kyriakides, TC, Matsumura, JS, Padberg, FT, Kohler, TR, Kougias, P, Jean-Claude, JM, Cikrit, DF & Swanson, KM 2012, 'Long-term comparison of endovascular and open repair of abdominal aortic aneurysm', New England Journal of Medicine, vol. 367, no. 21, pp. 1988-1997. https://doi.org/10.1056/NEJMoa1207481
Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT, Kohler TR et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. New England Journal of Medicine. 2012 Nov 22;367(21):1988-1997. https://doi.org/10.1056/NEJMoa1207481
Lederle, Frank A. ; Freischlag, Julie A. ; Kyriakides, Tassos C. ; Matsumura, Jon S. ; Padberg, Frank T. ; Kohler, Ted R. ; Kougias, Panagiotis ; Jean-Claude, Jessie M. ; Cikrit, Dolores F. ; Swanson, Kathleen M. / Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. In: New England Journal of Medicine. 2012 ; Vol. 367, No. 21. pp. 1988-1997.
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AU - Freischlag, Julie A.

AU - Kyriakides, Tassos C.

AU - Matsumura, Jon S.

AU - Padberg, Frank T.

AU - Kohler, Ted R.

AU - Kougias, Panagiotis

AU - Jean-Claude, Jessie M.

AU - Cikrit, Dolores F.

AU - Swanson, Kathleen M.

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N2 - BACKGROUND: Whether elective endovascular repair of abdominal aortic aneurysm reduces long-term morbidity and mortality, as compared with traditional open repair, remains uncertain. METHODS: We randomly assigned 881 patients with asymptomatic abdominal aortic aneurysms who were candidates for both procedures to either endovascular repair (444) or open repair (437) and followed them for up to 9 years (mean, 5.2). Patients were selected from 42 Veterans Affairs medical centers and were 49 years of age or older at the time of registration. RESULTS: More than 95% of the patients underwent the assigned repair. For the primary outcome of all-cause mortality, 146 deaths occurred in each group (hazard ratio with endovascular repair versus open repair, 0.97; 95% confidence interval [CI], 0.77 to 1.22; P = 0.81). The previously reported reduction in perioperative mortality with endovascular repair was sustained at 2 years (hazard ratio, 0.63; 95% CI, 0.40 to 0.98; P = 0.04) and at 3 years (hazard ratio, 0.72; 95% CI, 0.51 to 1.00; P = 0.05) but not thereafter. There were 10 aneurysm-related deaths in the endovascular-repair group (2.3%) versus 16 in the open-repair group (3.7%) (P = 0.22). Six aneurysm ruptures were confirmed in the endovascular-repair group versus none in the open-repair group (P = 0.03). A significant interaction was observed between age and type of treatment (P = 0.006); survival was increased among patients under 70 years of age in the endovascular-repair group but tended to be better among those 70 years of age or older in the open-repair group. CONCLUSIONS: Endovascular repair and open repair resulted in similar long-term survival. The perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected. (Funded by the Department of Veterans Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575).

AB - BACKGROUND: Whether elective endovascular repair of abdominal aortic aneurysm reduces long-term morbidity and mortality, as compared with traditional open repair, remains uncertain. METHODS: We randomly assigned 881 patients with asymptomatic abdominal aortic aneurysms who were candidates for both procedures to either endovascular repair (444) or open repair (437) and followed them for up to 9 years (mean, 5.2). Patients were selected from 42 Veterans Affairs medical centers and were 49 years of age or older at the time of registration. RESULTS: More than 95% of the patients underwent the assigned repair. For the primary outcome of all-cause mortality, 146 deaths occurred in each group (hazard ratio with endovascular repair versus open repair, 0.97; 95% confidence interval [CI], 0.77 to 1.22; P = 0.81). The previously reported reduction in perioperative mortality with endovascular repair was sustained at 2 years (hazard ratio, 0.63; 95% CI, 0.40 to 0.98; P = 0.04) and at 3 years (hazard ratio, 0.72; 95% CI, 0.51 to 1.00; P = 0.05) but not thereafter. There were 10 aneurysm-related deaths in the endovascular-repair group (2.3%) versus 16 in the open-repair group (3.7%) (P = 0.22). Six aneurysm ruptures were confirmed in the endovascular-repair group versus none in the open-repair group (P = 0.03). A significant interaction was observed between age and type of treatment (P = 0.006); survival was increased among patients under 70 years of age in the endovascular-repair group but tended to be better among those 70 years of age or older in the open-repair group. CONCLUSIONS: Endovascular repair and open repair resulted in similar long-term survival. The perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Endovascular repair led to increased long-term survival among younger patients but not among older patients, for whom a greater benefit from the endovascular approach had been expected. (Funded by the Department of Veterans Affairs Office of Research and Development; OVER ClinicalTrials.gov number, NCT00094575).

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