A 72-year-old man with an incidentally discovered 5.6 cm infrarenal abdominal aortic aneurysm (AAA) and hypertension is being assessed for repair. He is anatomically suitable for both EVAR and open repair. The EVAR-1 and DREAM trials established which long-term conclusion regarding EVAR versus open repair?
- A EVAR has superior long-term all-cause mortality compared to open repair
- B Open repair has better long-term survival due to higher EVAR graft-related complications
- C EVAR has lower perioperative mortality but equivalent long-term all-cause survival, with higher re-intervention rates ✓
- D EVAR is contraindicated in patients with hypertension due to graft endoleak risk
Explanation
Long-term follow-up data from the EVAR-1 trial (UK) and DREAM trial (Netherlands/Belgium) demonstrated that EVAR's initial 30-day mortality advantage (EVAR ~1.7% vs open ~4.7%) is lost over time due to late graft-related complications including endoleaks, graft migration, and need for secondary interventions. All-cause survival converges and becomes equivalent at 2-4 years. EVAR carries a significantly higher re-intervention rate (30-40% at 8 years vs ~10% for open). Current guidelines recommend EVAR as first-line where anatomically feasible for fit patients due to lower perioperative risk, with mandatory lifelong surveillance.
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.