The Impact of Recent European Trials on Abdominal Aortic Aneurysm Repair: Is a Paradigm Shift Warranted?

Long-term outcomes and resource utilization of endovascular versus open repair of abdominal aortic aneurysms in Ontario

“…17,18 Certain reservations about the conclusions of the randomized trials were presented and EVAR use continued to increase. 19 Limited, generalizable population-based data are available to compare long-term outcomes of EVAR with open AAA repair. A recent large American population-based review of Medicare A and B beneficiaries Ն67 years of age demonstrated an initial survival advantage for up to 3 years in patients undergoing EVAR but with an increase in AAA-related reinterventions.…”

Preferences for endovascular (EVAR) or open surgical repair among patients with abdominal aortic aneurysms under surveillance

“…[1][2][3] The technique has evolved significantly but research continues into both the technologic aspects of EVAR and the assessment of long-term outcomes, [4][5][6][7] and arguments about the cost-effectiveness of EVAR continue to occupy clinicians, particularly in state-funded healthcare systems. 8,9 Lower postoperative morbidity and mortality rates would favor the use of endovascular repair, but these need to be balanced against higher late-complication and reintervention rates and the need for long-term surveillance.…”

Abdominal Aortic Aneurysms: Changing Paradigms in Treatment

“…17 Depending on interpretation and resources this information may help determine when to treat patients with smaller AAA at an earlier stage. Further, it has been suggested that the threshold in women be even lower (e.g., 4.5 cm in diameter) based on women's relatively smaller aortic dimensions, which appear to play a role in their higher risk of rupture and its attendant mortality and in their 18 lower anatomical suitability for EVAR 14,18,19 While in the past there was "no disagreement about appropriate treatment for large AAAs in patients with unsuitable anatomic characteristics that preclude EVAR, these patients should have conventional open repair, which has been reported to have low morbidity and mortality rates 14 . The advancement of technology has steadily whittled away at these anatomic criteria and continues to push the safe and acceptable anatomical criteria further into what was once considered to be the experimental or anatomically unacceptable range.…”

“…This, like the intention to treat, may provide more numbers for statistical analysis and to a certain extent some comparability and useful information however it has been confused in certain situations with aneurysm related death, which would be a much more useful piece of information to know about in the clinical setting. Aneurysm-related death can only be accurately determined by directly witnessed objective information, e.g., postmortem examination or rupture seen on an imaging study prior to death 14 . This however is difficult to obtain with decreasing numbers of autopsies being performed, deaths outside of the hospital and incomplete communication amongst healthcare systems.…”