Similar survival rates with endovascular, open aneurysm repair

Nov 26 2012

By Piriya Mahendra, medwireNews Reporter

Endovascular and open repair of abdominal aortic aneurysm result in similar long-term survival rates, say researchers in TheNew England Journal of Medicine.

Frank Lederle (Veterans Affairs Medical Centers, Minneapolis, Minnesota, USA) report the long-term results of the Open versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study, which at 2 years saw no excess late deaths in the endovascular repair group.

In the current long-term analysis, they found that the perioperative survival advantage with endovascular repair was sustained for several years, but rupture after repair remained a concern. Furthermore, endovascular repair led to increased long-term survival among younger but not older patients.

The randomized study included 881 patients aged 49 years or over who experienced asymptomatic abdominal aortic aneurysms and were eligible for either endovascular repair (n=444) or open repair (n=437). All participants were followed up for 9 years.

Overall, 146 all-cause deaths occurred in each group, at a hazard ratio (HR) of 0.97 for the endovascular versus open repair group. There was a sustained reduction in all-cause mortality at 2 years, at a HR of 0.63, and at 3 years, at a HR of 0.72, but not thereafter.

There were 10 aneurysm-related deaths in the endovascular repair group at 2.3% versus 3.7% in the open repair group. Six aneurysm ruptures were confirmed in the endovascular repair group versus none in the open repair group.

There was a significant interaction between age and type of treatment: survival increased among patients under 70 years of age in the endovascular repair group, but tended to be better in those aged 70 years or older in the open repair group.

"Our results suggest that endovascular repair continues to improve and is now an acceptable alternative to open repair even when judged in terms of long-term survival," write the authors.

"However, our results also indicate that late rupture remains a concern and that endovascular repair does not yet offer a long-term advantage over open repair, particularly among older patients, for whom such an advantage was originally expected."

In a related editorial Joshua Beckman (Bingham and Women's Hospital, Boston, Massachusetts, USA) says: "Endovascular repair has neither expanded AAA repair to new populations nor reduced long-term mortality when compared with open repair. The dream of improving long-term survival and expanding the population that will benefit from AAA repair is seemingly over, but the reality of better procedural recovery for patients today is certainly a step forward."

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