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Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms.

Abstract：

OBJECTIVE:Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair. METHODS:We updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis. RESULTS:There were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up. CONCLUSIONS:During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

van Schaik TG,Yeung KK,Verhagen HJ,de Bruin JL,van Sambeek MRHM,Balm R,Zeebregts CJ,van Herwaarden JA,Blankensteijn JD,DREAM trial participants.

doi

10.1016/j.jvs.2017.05.122

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

1379-1389

issue

5

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(17)31758-5

journal_volume

66

pub_type

杂志文章,多中心研究,随机对照试验

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