A 72-year-old man with a 6.2 cm infrarenal abdominal aortic aneurysm (AAA) is assessed for repair. He has COPD (FEV1 55% predicted) and creatinine 130 µmol/L. Which outcome does the EVAR-1 trial most importantly demonstrate when comparing EVAR to open repair in this patient's risk profile?
- A EVAR has lower perioperative mortality but similar or worse long-term all-cause survival ✓
- B EVAR has superior 10-year all-cause mortality compared to open repair
- C EVAR is contraindicated in patients with CKD
- D Open repair is superior in high-risk patients due to lower re-intervention rates
Explanation
The EVAR-1 trial demonstrated that endovascular repair (EVAR) of infrarenal AAA has significantly lower perioperative 30-day mortality (1.7% vs 4.7%) compared to open repair. However, long-term follow-up showed convergence and eventual loss of survival benefit by 8 years, with higher rates of endoleak, device-related re-intervention, rupture, and aneurysm-related deaths in the EVAR group. All-cause 10-year mortality was similar between groups. Therefore, EVAR is favored for high-risk patients (COPD, renal impairment) where perioperative risk is highest, accepting the need for lifelong surveillance and re-intervention.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.