The impact of recent European trials on abdominal aortic aneurysm repair: is a paradigm shift warranted?

Published

Journal Article (Review)

Recent reports, following upon the reported outcomes of European randomized prospective trials of endovascular abdominal aortic aneurysm repair (EVAR), have brought into question the appropriateness of some of the trials' main conclusions, particularly in patients deemed at high-risk for surgical intervention. Based on the data of these trials, specifically EVAR 2, it has been suggested that EVAR should not be performed in high-risk individuals due to the likelihood of poor outcomes and the lack of improved survival, both associated with higher costs. In addition, certain aspects of the trials involving those deemed fit for open repair (the EVAR 1 and Dutch Randomized Endovascular Aneurysm Management trials) deserve qualified reservations. Although prospective, randomized United States trial data on such patients are not currently available, some large retrospective studies and registry reviews provide a basis for comparison of these trials with US EVAR experiences. In this review, the European EVAR trials are analyzed along with these other US studies and the rationale for modifying some of the conclusions drawn from the trials is presented and general guidelines for the selective management of abdominal aortic aneurysm patients presenting with potential indications for intervention are proposed.

Full Text

Duke Authors

Cited Authors

  • Bush, RL; Mureebe, L; Bohannon, WT; Rutherford, RB

Published Date

  • August 2008

Published In

Volume / Issue

  • 148 / 2

Start / End Page

  • 264 - 271

PubMed ID

  • 17996903

Pubmed Central ID

  • 17996903

Electronic International Standard Serial Number (EISSN)

  • 1095-8673

Digital Object Identifier (DOI)

  • 10.1016/j.jss.2007.06.023

Language

  • eng

Conference Location

  • United States