 |
|
Outcomes Following Endovascular vs Open Repair of Abdominal Aortic AneurysmA Randomized Trial
Frank A. Lederle, MD;
Julie A. Freischlag, MD;
Tassos C. Kyriakides, PhD;
Frank T. Padberg Jr, MD;
Jon S. Matsumura, MD;
Ted R. Kohler, MD;
Peter H. Lin, MD;
Jessie M. Jean-Claude, MD;
Dolores F. Cikrit, MD;
Kathleen M. Swanson, MS, RPh;
Peter N. Peduzzi, PhD; for the Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group
JAMA. 2009;302(14):1535-1542.
Context Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair.
Objective To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial.
Design, Setting, and Patients A randomized, multicenter clinical trial of 881 veterans (aged  49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008.
Intervention Elective endovascular (n = 444) or open (n = 437) repair of AAA.
Main Outcome Measures Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality.
Results Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function.
Conclusions In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures.
Trial Registration clinicaltrials.gov Identifier: NCT00094575
Author Affiliations: Medicine Service, Veterans Affairs Medical Center, Minneapolis, Minnesota (Dr Lederle); Surgery Service, Veterans Affairs Medical Center, Baltimore, Maryland (Dr Freischlag); Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, West Haven, Connecticut (Drs Kyriakides and Peduzzi); Surgery Service, Veterans Affairs Medical Center, East Orange, New Jersey (Dr Padberg); Surgery Service, Veterans Affairs Medical Center, Madison, Wisconsin (Dr Matsumura); Surgery Service, Veterans Affairs Medical Center, Seattle, Washington (Dr Kohler); Surgery Service, Veterans Affairs Medical Center, Houston, Texas (Dr Lin); Surgery Service, Veterans Affairs Medical Center, Cleveland, Ohio (Dr Jean-Claude); Surgery Service, Veterans Affairs Medical Center, Indianapolis, Indiana (Dr Cikrit); and Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico (Ms Swanson).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
A 66-Year-Old Man With an Abdominal Aortic Aneurysm: Review of Screening and Treatment
Schermerhorn
JAMA 2009;302:2015-2022.
ABSTRACT
| FULL TEXT
Shared Accountability, Appropriateness, and Quality of Surgical Care
Zeller and Fontanarosa
JAMA 2009;302:1590-1591.
FULL TEXT
|
