The EVAR 1 trial compared endovascular aneurysm repair (EVAR) with open surgical repair for infrarenal AAA ≥5.5 cm. What was the long-term finding at 15-year follow-up?
- A EVAR maintained its 30-day mortality benefit and overall survival advantage over open repair at 15 years
- B EVAR's early mortality benefit was not sustained; long-term all-cause and aneurysm-related mortality were higher in the EVAR group due to secondary interventions and device-related failures ✓
- C Open repair had higher perioperative mortality but significantly better long-term survival
- D Both groups had equivalent long-term survival with no difference in secondary interventions
Explanation
EVAR 1 (UK) showed that EVAR had a significant 30-day mortality advantage over open repair (~1.8% vs 4.3%). However, at 8-year follow-up and confirmed at 15 years, this early survival advantage was lost. EVAR was associated with significantly higher rates of graft-related complications (endoleaks, limb thrombosis, device migration) requiring reinterventions, and had higher late aneurysm-related rupture and mortality than open repair. Overall long-term all-cause mortality was also higher in the EVAR group, driven by aneurysm-related deaths. This has led to more cautious patient selection for EVAR, emphasizing anatomical suitability, surveillance compliance, and patient fitness for secondary interventions.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.