Outcomes following endovascular vs open repair of abdominal aortic aneurysm

A randomized trial

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

Research output: Contribution to journalArticle

Abstract

Context: 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. Design, Setting, and Patients: A randomized, multicenter clinical trial of 881 veterans (aged ≥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. Intervention: Elective endovascular (n=444) or open (n=437) repair of AAA. Main Outcome Measures: 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. Trial Registration: clinicaltrials.gov Identifier: NCT00094575.

Original languageEnglish (US)
Pages (from-to)1535-1542
Number of pages8
JournalJournal of the American Medical Association
Volume302
Issue number14
DOIs
StatePublished - Oct 14 2009
Externally publishedYes

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Abdominal Aortic Aneurysm
Mortality
Veterans
Morbidity
Length of Stay
Quality of Life
Endovascular Procedures
Fluoroscopy
Erectile Dysfunction
Artificial Respiration
Multicenter Studies
Aneurysm
Intensive Care Units
Inpatients
Hospitalization
Randomized Controlled Trials
Outcome Assessment (Health Care)
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lederle, F. A., Freischlag, J. A., Kyriakides, T. C., Padberg, F. T., Matsumura, J. S., Kohler, T. R., ... Peduzzi, P. N. (2009). Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. Journal of the American Medical Association, 302(14), 1535-1542. https://doi.org/10.1001/jama.2009.1426

Outcomes following endovascular vs open repair of abdominal aortic aneurysm : A randomized trial. / Lederle, Frank A.; Freischlag, Julie A.; Kyriakides, Tassos C.; Padberg, Frank T.; Matsumura, Jon S.; Kohler, Ted R.; Lin, Peter H.; Jean-Claude, Jessie M.; Cikrit, Dolores F.; Swanson, Kathleen M.; Peduzzi, Peter N.

In: Journal of the American Medical Association, Vol. 302, No. 14, 14.10.2009, p. 1535-1542.

Research output: Contribution to journalArticle

Lederle, FA, Freischlag, JA, Kyriakides, TC, Padberg, FT, Matsumura, JS, Kohler, TR, Lin, PH, Jean-Claude, JM, Cikrit, DF, Swanson, KM & Peduzzi, PN 2009, 'Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial', Journal of the American Medical Association, vol. 302, no. 14, pp. 1535-1542. https://doi.org/10.1001/jama.2009.1426
Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT, Matsumura JS, Kohler TR et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial. Journal of the American Medical Association. 2009 Oct 14;302(14):1535-1542. https://doi.org/10.1001/jama.2009.1426
Lederle, Frank A. ; Freischlag, Julie A. ; Kyriakides, Tassos C. ; Padberg, Frank T. ; Matsumura, Jon S. ; Kohler, Ted R. ; Lin, Peter H. ; Jean-Claude, Jessie M. ; Cikrit, Dolores F. ; Swanson, Kathleen M. ; Peduzzi, Peter N. / Outcomes following endovascular vs open repair of abdominal aortic aneurysm : A randomized trial. In: Journal of the American Medical Association. 2009 ; Vol. 302, No. 14. pp. 1535-1542.
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abstract = "Context: 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. Design, Setting, and Patients: A randomized, multicenter clinical trial of 881 veterans (aged ≥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. Intervention: Elective endovascular (n=444) or open (n=437) repair of AAA. Main Outcome Measures: 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. Trial Registration: clinicaltrials.gov Identifier: NCT00094575.",
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AU - Padberg, Frank T.

AU - Matsumura, Jon S.

AU - Kohler, Ted R.

AU - Lin, Peter H.

AU - Jean-Claude, Jessie M.

AU - Cikrit, Dolores F.

AU - Swanson, Kathleen M.

AU - Peduzzi, Peter N.

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N2 - Context: 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. Design, Setting, and Patients: A randomized, multicenter clinical trial of 881 veterans (aged ≥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. Intervention: Elective endovascular (n=444) or open (n=437) repair of AAA. Main Outcome Measures: 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. Trial Registration: clinicaltrials.gov Identifier: NCT00094575.

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