The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open repair for AAA. What was the key long-term finding that changed practice regarding EVAR surveillance?

• A EVAR had equivalent 30-day and long-term mortality to open repair; no surveillance required after 2 years
• B EVAR had lower 30-day mortality and superior long-term survival due to reduced perioperative cardiac events
• C EVAR was inferior to open repair in aneurysm-related mortality at 10 years in patients with favourable anatomy
• D EVAR had lower 30-day mortality but higher long-term all-cause mortality at 8 years due to graft-related complications requiring life-long surveillance and re-intervention ✓

Explanation

EVAR-1 demonstrated that EVAR conferred a significant early (30-day) mortality advantage over open repair (~1.7% vs 4.7%) but that this advantage was lost by 8 years, with equivalent all-cause mortality. Graft-related complications (endoleak, graft migration, rupture, limb thrombosis) requiring secondary interventions occurred in approximately 27% of EVAR patients over 8 years. This mandates life-long CT surveillance after EVAR. The OVER trial (US) similarly showed initial EVAR survival benefit disappearing by 5-9 years. Open repair, when technically feasible, remains durable without ongoing surveillance burden.

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

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Written and medically reviewed by the StethoPrep medical team.