A 70-year-old man with a 5.6 cm infrarenal abdominal aortic aneurysm (AAA) is fit for intervention. He has no aortic neck angulation and good iliac anatomy. The EVAR1 trial and subsequent data inform the choice between open repair (OR) and endovascular aneurysm repair (EVAR). Which statement best summarises the long-term comparative outcome?
- A EVAR has lower 30-day mortality but long-term all-cause mortality is similar to OR, with EVAR requiring more reinterventions ✓
- B EVAR is superior to OR in both 30-day and 10-year all-cause mortality
- C OR has lower 30-day mortality and superior long-term outcomes due to absence of endoleak
- D EVAR and OR have identical 30-day mortality rates but EVAR has fewer reinterventions
Explanation
The EVAR1 trial confirmed that EVAR has significantly lower perioperative (30-day) mortality (~1.7% vs ~4.7% for OR) in fit patients. However, long-term (8–10 year) all-cause mortality is similar between the two approaches as the early survival benefit of EVAR is lost over time. EVAR is associated with a significantly higher reintervention rate due to endoleak, device migration, and sac enlargement, necessitating lifelong surveillance. OR, if survived, is more durable without the need for surveillance-driven reinterventions. EVAR remains preferred for high-risk surgical candidates.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.