A 72-year-old man with a 5.8 cm asymptomatic infrarenal abdominal aortic aneurysm (AAA) is fit for surgery. Comparing open repair versus EVAR, which finding from the EVAR-1 trial is most clinically relevant at 15-year follow-up?

• A EVAR has superior long-term overall survival compared to open repair
• B Open repair has lower perioperative mortality but better long-term freedom from re-intervention
• C EVAR and open repair have identical outcomes at 15 years
• D EVAR has lower perioperative mortality but similar long-term overall survival with higher late re-intervention rates ✓

Explanation

EVAR-1 (UK multicenter trial) compared EVAR versus open repair for AAA ≥5.5 cm in fit patients. Long-term follow-up showed: EVAR had significantly lower 30-day mortality (1.7% vs 4.7%) but this early benefit was lost by 4 years. Long-term overall survival was similar between groups. EVAR had significantly higher late re-intervention rates (32% vs 19% at 8 years) due to endoleaks, migration, and stent-graft complications, requiring lifelong surveillance with CT. Late rupture after EVAR (device failure) occasionally occurred. Current practice still favors EVAR in suitable anatomy due to lower perioperative risk, but patients must understand the need for lifelong imaging follow-up.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.