Document Detail

Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial.
MedLine Citation:
PMID:  23549424     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Randomized comparison of endovascular repair (EVAR) with open repair (OR) in patients with a ruptured abdominal aortic aneurysm (RAAA).
BACKGROUND: Despite advances in operative technique and perioperative management RAAA remains fraught with a high rate of death and complications. Outcome may improve with a minimally invasive surgical technique: EVAR.
METHODS: All patients with a RAAA in the larger Amsterdam area were identified. Logistics for RAAA patients was changed with centralization of care in 3 trial centers. Patients both fit for EVAR and for OR were randomized to either of the treatments. Nonrandomized patients were followed in a prospective cohort. Primary endpoint of the study was the composite of death and severe complications at 30 days.
RESULTS: Between April 2004 and February 2011, we identified 520 patients with a RAAA of which 116 could be randomized. The primary endpoint rate for EVAR was 42% and for OR was 47% [absolute risk reduction (ARR) = 5.4%; 95% confidence interval (CI): -13% to +23%]. The 30-day mortality was 21% in patients assigned to EVAR compared with 25% for OR (ARR = 4.4% 95% CI: -11% to +20%). The mortality of all surgically treated patients in the nonrandomized cohort was 30% (95% CI: 26%-35%) and 26% (95% CI: 20% to 32%) in patients with unfavorable anatomy for EVAR, treated by OR at trial centers.
CONCLUSIONS: This trial did not show a significant difference in combined death and severe complications between EVAR and OR. Mortality for OR both in randomized patients and in cohort patients was lower than anticipated, which may be explained by optimization of logistics, preoperative CT imaging, and centralization of care in centers of expertise.
Jorik J Reimerink; Liselot L Hoornweg; Anco C Vahl; Willem Wisselink; Ted A A van den Broek; Dink A Legemate; Jim A Reekers; Ron Balm;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Annals of surgery     Volume:  258     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-10     Completed Date:  2013-09-10     Revised Date:  2013-11-12    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  248-56     Citation Subset:  AIM; IM    
Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality,  surgery*
Aortic Rupture / mortality,  surgery*
Blood Vessel Prosthesis Implantation / methods*
Endovascular Procedures*
Hospital Mortality
Intention to Treat Analysis
Kaplan-Meier Estimate
Middle Aged
Postoperative Complications / epidemiology
Treatment Outcome
R Balm / ; L L Hoornweg / ; J J Reimerink / ; A C Vahl / ; W Wisselink / ; T A A van den Broek / ; D A Legemate / ; J A Reekers / ; J J Reimerink / ; A C Vahl / ; W Wisselink / ; B Eikelboom / ; B A J de Mol / ; J G P Tijssen / ; M N Storm-Versloot / ; L L Hoornweg / ; M N Storm-Versloot / ; S C van Beek / ; J D Blankensteijn / ; M J Koelemay / ; T V Schrïoder / ; M J W Koelemay / ; M M Idu / ; C Kox / ; D A Legemate / ; L C Huisman / ; M C M Willems / ; J A Reekers / ; O M van Delden / ; K P van Lienden / ; A C Vahl / ; V J Leijdekkers / ; J Bosma / ; A D Montauban-van Swijndregt / ; C de Vries / ; V P M van der Hulst / ; J Peringa / ; J G A Blomjous / ; M J T Visser / ; W Wisselink / ; A W J Hoksbergen / ; J D Blankensteijn / ; H M E Coveliers / ; J H Nederhoed / ; F G van den Berg / ; B B van der Meijs / ; M L P van den Oever / ; R J Lely / ; M R Meijerink / ; A Voorwinde / ; J M Ultee / ; R C van Nieuwenhuizen Slotervaartziekenhuis / ; B J Dwars / ; T O M Nagy / ; P Tolenaar / ; J A Lawson / ; P J van Aken / ; T A A van den Broek / ; W Mulder / ; D Nio / ; G J M Akkersdijk / ; P van Exter /

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