The EVAR-1 trial established that endovascular aortic aneurysm repair (EVAR) versus open repair for AAA >5.5 cm provides what survival advantage at 15 years?
- A EVAR has superior early (30-day) mortality but similar long-term survival; open repair is equivalent by 8 years ✓
- B EVAR provides sustained long-term survival benefit at 15 years
- C Open repair is superior to EVAR from 1 year onwards
- D EVAR is inferior at all time points due to re-intervention rates
Correct answer: A. EVAR has superior early (30-day) mortality but similar long-term survival; open repair is equivalent by 8 years
Explanation
EVAR-1 long-term data (15 years) confirmed EVAR has lower 30-day operative mortality (~1.8% vs ~4.3% open), but aneurysm-related survival advantage disappears by 8 years due to late EVAR-related complications (endoleaks, device failure) requiring re-intervention. All-cause mortality is similar in the long term. This has driven consensus that EVAR requires lifelong surveillance and that younger, fit patients may benefit from open repair's durability.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.