The EVAR-1 trial compared endovascular aneurysm repair (EVAR) versus open repair for abdominal aortic aneurysm (AAA) in patients fit for both. What is the most clinically important long-term finding?
- A EVAR is superior in both perioperative and long-term mortality
- B Open repair has better long-term freedom from reintervention
- C EVAR has superior perioperative mortality but equivalent long-term overall survival ✓
- D Both techniques have identical perioperative mortality rates
Correct answer: C. EVAR has superior perioperative mortality but equivalent long-term overall survival
Explanation
The EVAR-1 trial (UK) demonstrated that EVAR has lower 30-day (perioperative) mortality compared to open surgical repair. However, at long-term follow-up (up to 15 years), this early mortality benefit was lost due to higher rates of late complications including endoleak, graft migration, and rupture requiring reintervention in the EVAR group. Overall long-term survival was not significantly different between the two groups. EVAR thus requires lifelong imaging surveillance.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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