The EVAR-1 trial compared endovascular aneurysm repair (EVAR) versus open surgery for abdominal aortic aneurysm (AAA). Which of the following most accurately summarises its long-term findings?
- A EVAR confers a sustained long-term survival advantage over open repair beyond 10 years
- B EVAR has lower 30-day mortality but no long-term all-cause survival benefit, with higher rates of reintervention and late rupture ✓
- C Open repair has lower 30-day mortality than EVAR for elective AAA
- D EVAR and open repair have equivalent 30-day mortality and long-term survival
Correct answer: B. EVAR has lower 30-day mortality but no long-term all-cause survival benefit, with higher rates of reintervention and late rupture
Explanation
The EVAR-1 trial showed EVAR has significantly lower perioperative (30-day) aneurysm-related mortality compared to open repair. However, this early survival advantage was not maintained at long-term follow-up (8-15 years), with EVAR patients having higher rates of device-related complications, reintervention, endoleak, and late aneurysm rupture, and no difference in all-cause mortality. Lifelong surveillance with CT or duplex ultrasound is mandatory after EVAR. The EVAR-2 trial assessed EVAR versus best medical therapy in patients unfit for open surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.