Endovascular vs. Open Repair for Suspected Ruptured Abdominal Aortic Aneurysm

June 22, 2018 by Dr. Clemens Leave a Comment

IMPROVE Trial Investigators. BMJ 2017 Nov 14.

Three-year mortality was lower with endovascular repair.

In a previously reported U.K. trial of 613 patients with clinically suspected rupture of abdominal aortic aneurysm (AAA), 30-day mortality and hospital costs were similar in patients randomized to endovascular repair (in those with suitable aortic anatomy) and patients randomized to open repair; ruptures were confirmed in 502 patients (NEJM JW Gen Med Mar 1 2014 and BMJ 2014; 348:f7661). Now, the investigators report 3-year outcomes.

Mortality was similar between groups at 90 days. It was significantly lower in the endovascular group than in the open-repair group at 3 years (48% vs. 56%), but not at 7 years (≈60% in both groups). Quality of life was higher in the endovascular group at 1 year but was similar between groups at 3 years. When incremental costs and quality-adjusted life-years were considered, endovascular repair was more cost-effective. Results generally were similar among patients with confirmed rupture. Aneurysm-related reintervention rates were similar in the two groups.

COMMENT

In this randomized trial, endovascular repair for suspected ruptured AAA, compared with open repair, was associated with lower mortality at 3 years, better early quality of life, and fewer hospital days; it also was more cost-effective. These results support an endovascular approach for patients with ruptured AAAs. Why survival converged beyond 3 years is unclear, but it might be related to patient characteristics (e.g., advanced age, comorbidities).

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