The EVAR-1 trial compared endovascular aneurysm repair (EVAR) versus open repair for infrarenal AAA. What was the key finding regarding long-term overall survival?
- A EVAR had lower perioperative mortality and maintained long-term survival advantage
- B Open repair had equivalent perioperative mortality and better long-term results
- C EVAR had lower perioperative mortality but no long-term overall survival advantage due to late EVAR-related deaths ✓
- D EVAR improved survival only in patients over 75 years
Correct answer: C. EVAR had lower perioperative mortality but no long-term overall survival advantage due to late EVAR-related deaths
Explanation
The EVAR-1 trial showed that EVAR had significantly lower 30-day perioperative mortality (1.7% vs 4.7%) compared to open repair. However, at long-term follow-up (8+ years), the survival advantage was lost and EVAR was associated with more late complications (endoleak, device migration, rupture) and higher reintervention rates, with slightly higher late EVAR-related aneurysm deaths. The initial perioperative benefit did not translate to an overall survival advantage. This has led to careful patient selection for EVAR with lifelong surveillance requirements.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.