A 72-year-old male smoker has a 6.2 cm asymptomatic abdominal aortic aneurysm (AAA). Cardiac risk assessment reveals significant coronary artery disease. Which statement best reflects the evidence from the UK EVAR trials 1 and 2 regarding treatment selection?
- A EVAR 2: EVAR in patients unfit for open repair provides survival benefit over best medical treatment
- B EVAR 1: EVAR has lower 30-day mortality than open repair but loses long-term survival advantage due to late EVAR-related deaths ✓
- C Open repair is always preferred for large AAAs regardless of co-morbidities
- D EVAR is associated with lower long-term mortality than open repair on 15-year follow-up
Explanation
The UK EVAR 1 trial (NEJM/Lancet) showed EVAR had a significantly lower 30-day operative mortality (~1.7% vs ~4.7% for open repair) but at long-term follow-up (8+ years), the late survival advantage was lost, and by 15 years, EVAR was associated with excess late AAA-related deaths due to graft complications, endoleaks, and rupture; open repair survivors had superior long-term AAA-specific outcomes. EVAR 2 (patients unfit for open repair) showed EVAR did not improve overall survival compared to observation/best medical treatment due to the poor underlying health of the cohort and ongoing EVAR-related complications. These findings reinforced the need for lifelong EVAR 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.