The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open repair for abdominal aortic aneurysm. What was the 10-year follow-up finding that tempered initial enthusiasm for EVAR?
- A EVAR had significantly higher 30-day mortality than open repair
- B EVAR was associated with higher rates of renal failure compared to open repair
- C EVAR's early mortality advantage was lost at 10 years, with similar all-cause mortality and higher reintervention rates due to endoleaks and graft complications ✓
- D EVAR was found to be cost-effective at all time points beyond 2 years
Correct answer: C. EVAR's early mortality advantage was lost at 10 years, with similar all-cause mortality and higher reintervention rates due to endoleaks and graft complications
Explanation
EVAR-1 (UK) showed that EVAR had lower 30-day mortality (1.8% vs 4.3%) and was the preferred early approach. However, at 10-year follow-up, the all-cause mortality was similar between EVAR and open repair, and EVAR was associated with significantly higher reintervention rates due to type II endoleaks, device migration, and graft-related complications. EVAR also incurred higher long-term cost. This led to the understanding that EVAR requires lifelong surveillance and has a late catch-up effect, prompting patient selection based on anatomy and operative risk.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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