Endovascular Aneurysm Repair Versus Open Repair in Patients With Abdominal Aortic Aneurysm (EVAR Trial i): Randomized Controlled Trial

The authors report the results of a trial randomized controlled trial of 1082 patients aged 60 years or older with large abdominal aortic aneurysms (5.5 cm or larger in diameter) in which endovascular aneurysm repair (EVAR) was compared with open repair. The variables compared were cost, mortality, complications, durability, and health-related quality of life. At the 4-year follow-up, the two groups had similar rates of all-cause mortality, but the EVAR group had a persistent reduction in aneurysm-related deaths. In the EVAR group 41% had experienced a postoperative complication compared with 9% in the open repair group. At the end of 1 year, there were no differences in health-related quality of life. The authors concluded that EVAR is more expensive (about one third higher costs), has more complications and reinterventions, but offers a 3% better aneurysm-related survival.