The EVAR-1 trial compared endovascular aneurysm repair (EVAR) with open surgical repair for AAA >5.5 cm in fit patients. The long-term (15-year) finding showed:
- A EVAR had superior all-cause mortality benefit over open repair
- B Open repair had higher 30-day mortality but comparable long-term outcomes
- C EVAR had lower perioperative mortality but no long-term all-cause mortality benefit, with higher late rupture and reintervention rates ✓
- D EVAR had identical reintervention rates to open repair after 5 years
Correct answer: C. EVAR had lower perioperative mortality but no long-term all-cause mortality benefit, with higher late rupture and reintervention rates
Explanation
EVAR-1 demonstrated that EVAR had significantly lower 30-day mortality (1.8% vs 4.3%) and short-term aneurysm-related mortality advantage, but this benefit was lost by 8 years. By 15 years, EVAR patients had higher rates of late AAA-related death, endoleak, rupture, and reintervention compared to open repair. This emphasised the need for lifelong CT surveillance after EVAR.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.