The EVAR-1 trial (Endovascular Aneurysm Repair 1) compared EVAR with open surgical repair for abdominal aortic aneurysm (AAA). Which is the correct long-term finding?
- A EVAR has lower perioperative mortality but no long-term all-cause survival advantage; higher reintervention rate ✓
- B EVAR has lower 30-day mortality and sustained long-term survival benefit over open repair
- C Open repair is superior in all outcomes including perioperative mortality and long-term survival
- D EVAR eliminates the need for lifelong surveillance after AAA repair
Correct answer: A. EVAR has lower perioperative mortality but no long-term all-cause survival advantage; higher reintervention rate
Explanation
EVAR-1 demonstrated that EVAR significantly reduces 30-day mortality compared to open repair (1.8% vs 4.3%). However, long-term follow-up showed no difference in all-cause survival between groups by 8 years. EVAR is associated with a higher rate of graft-related complications (endoleaks, migration, rupture) requiring reinterventions, necessitating lifelong CT surveillance. EVAR-2 evaluated EVAR vs no intervention in patients unfit for open repair and showed no survival benefit. Lifelong surveillance is mandatory after EVAR.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.