Original title: Long Term Comparison of Endovascular and Repair of Abdominal Aortic Aneurysm (OVER TRIAL) Reference: Frank A. Lederle, et al. NEJM 367;24:1988-1997

Randomized studies had shown that the endovascular approach reduces mortality, yet its long term evolution remained a concern. 

The aim of this study was to analyze long term evolution of EVAR device implantation vs. conventional open surgery (OS) in treating Abdominal Aorta Aneurysm (AAA). This randomized trial included 881 patients (444 in the EVAR group and 437 in the OS group). 

Patients were eligible for the study if the aneurysm had a maximum external diameter of at least 50 mm. Primary end point was long-term mortality from any cause and secondary end point was quality of life and erectile dysfunction.

Baseline characteristics were similar for both populations. Long-term follow up (8 years) showed no difference in all-cause mortality rate in both groups (32.9% vs. 33.4% p=0.81), neither were differences in associated mortality rate (2.3% vs. 3.7% p=0.22). 

Secondary end point did not show significant differences. Long-term survival rate in patients younger than 70 was better in the EVAR group (hazard ratio 0.65; 95% CI, 0.43 to 0.98; p=0.04); this difference was not observed in patients older than 70 (hazard ratio,1.31;95% CI; 0.99 a 1.73; p=0.06).

Conclusion 

In this randomized study, infrarenal AAA repair showed similar results with both procedures in the long-term. Survival rate was better in patients

Editorial Comment:

In this multicenter randomized trial comparing AAA repair with EVAR vs. OS, there were no significant differences in long-term mortality rate, which are promising results considering aortic endoprosthesis implants reduce hospitalization time and facilitates recovery without altering quality of life, compared to the traditional open surgery. It is worth noting that the results for patients over 70, which were intuitively supposed to benefit more from this approach, were not the expected. However, further advances in new devices will bring the same, and even better, results in the treatment of more complex AAA. 

Courtesy of Carlos Fava, MD
Interventional cardiologist
Fundación Favaloro – Argentina

Dr. Carlos Fava para SOLACI.ORG