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Again, Similar Outcomes for Endovascular vs. Open Repair of Ruptured Abdominal Aortic Aneurysms

February 11, 2014

Again, Similar Outcomes for Endovascular vs. Open Repair of Ruptured Abdominal Aortic Aneurysms

  1. Paul S. Mueller, MD, MPH, FACP

But endovascular patients were more likely to be discharged directly to home.

  1. Paul S. Mueller, MD, MPH, FACP

Evidence is mixed on whether endovascular repair is associated with lower mortality than is open surgical repair in patients with ruptured abdominal aortic aneurysms (AAAs). In a recent small trial, short-term mortality was similar with the two procedures (NEJM JW Gen Med Aug 27 2013). In this multicenter trial from the U.K., investigators compared 30-day mortality and hospital costs in 613 patients (age, >50; 78% men) with suspected ruptured AAAs who were randomized to endovascular repair (316 patients, 275 with confirmed ruptures and 174 anatomically suitable for endovascular repair) or open surgical repair (297 patients, 261 with confirmed ruptures).

At 30 days, mortality was 35% in the endovascular group and 37% in the open-repair group — a nonsignificant difference. Average hospital costs were similar in both groups. However, significantly more patients in the endovascular group were discharged directly to home (94% vs. 77%). Notably, subgroup analysis suggested that women in the endovascular group had lower 30-day mortality than women in the open-repair group.

Comment

In this “real-world” trial, endovascular repair, compared with open repair, did not lower 30-day mortality in patients with ruptured abdominal aortic aneurysms. Although 30-day postrandomization costs were similar in both groups, more patients who received endovascular repair were discharged directly to home, which, in turn, might be associated with lower costs and improved quality of life. Whether an endovascular strategy is superior to an open-repair strategy in women should be confirmed by additional studies.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Secretary)

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