The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open repair for infrarenal AAA ≥5.5 cm. At 15-year follow-up, which of the following best describes the outcome?
- A EVAR had a persistent late survival advantage over open repair beyond 8 years
- B EVAR had lower early (30-day) mortality but required more late reinterventions; no long-term survival difference after crossover effects ✓
- C Open repair had superior long-term overall survival owing to fewer late reinterventions and ruptures in the EVAR group
- D Both modalities had equivalent 30-day mortality and equivalent long-term survival
Correct answer: B. EVAR had lower early (30-day) mortality but required more late reinterventions; no long-term survival difference after crossover effects
Explanation
EVAR-1 showed EVAR had significantly lower 30-day operative mortality (1.8% vs 4.3%). However, over 15 years, EVAR was associated with more late reinterventions (endoleak, graft migration) and AAA-related deaths from late graft complications, eliminating the early survival advantage. Overall mortality was similar. This underpins current practice: EVAR is preferred in high-risk patients, while open repair may be preferred in fit younger patients with expected long-term surveillance challenges.
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.