The EVAR-1 trial comparing endovascular aortic aneurysm repair (EVAR) versus open repair in patients fit for open surgery demonstrated which of the following long-term (10-year) outcomes?
- A EVAR's early 30-day mortality advantage was lost by 8 years due to late ruptures and endoleak-related deaths, with no long-term survival benefit ✓
- B EVAR had superior long-term all-cause mortality compared to open repair at 10 years
- C Open repair was associated with significantly higher operative mortality but better long-term survival
- D Both techniques had equivalent 30-day mortality with EVAR offering superior long-term freedom from re-intervention
Explanation
The EVAR-1 trial long-term (>10 year) follow-up showed that although EVAR had significantly lower 30-day operative mortality (1.8% vs. 4.3% for open repair), this early advantage was not maintained over time. By 8 years, all-cause mortality and aneurysm-related mortality curves converged and crossed, with EVAR patients experiencing significantly more late complications (endoleaks, graft-related complications, secondary interventions) requiring lifelong surveillance. Open repair, while having higher operative risk, offered more durable long-term protection against aneurysm-related events.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.