Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms

Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention...

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Vydané v:	Journal of vascular surgery Ročník 66; číslo 5; s. 1379
Hlavní autori:	van Schaik, Theodorus G, Yeung, Kak K, Verhagen, Hence J, de Bruin, Jorg L, van Sambeek, Marc R H M, Balm, Ron, Zeebregts, Clark J, van Herwaarden, Joost A, Blankensteijn, Jan D
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 01.11.2017
Predmet:	Aged Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Belgium Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Cause of Death Disease-Free Survival Endovascular Procedures - adverse effects Endovascular Procedures - mortality Female Humans Intention to Treat Analysis Kaplan-Meier Estimate Male Middle Aged Netherlands Postoperative Complications - diagnostic imaging Postoperative Complications - mortality Postoperative Complications - therapy Retreatment Risk Factors Time Factors Treatment Outcome
ISSN:	1097-6809, 1097-6809
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Abstract	Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair. We updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis. There were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up. During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.
AbstractList	Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair. We updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis. There were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up. During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues. Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair.OBJECTIVERandomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair.We updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis.METHODSWe updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis.There were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up.RESULTSThere were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up.During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.CONCLUSIONSDuring 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.
Author	Yeung, Kak K van Herwaarden, Joost A van Schaik, Theodorus G Zeebregts, Clark J Verhagen, Hence J van Sambeek, Marc R H M Blankensteijn, Jan D de Bruin, Jorg L Balm, Ron
Author_xml	– sequence: 1 givenname: Theodorus G surname: van Schaik fullname: van Schaik, Theodorus G organization: Division of Vascular Surgery, Department of Surgery, VU Medical Center, Amsterdam, The Netherlands – sequence: 2 givenname: Kak K surname: Yeung fullname: Yeung, Kak K organization: Division of Vascular Surgery, Department of Surgery, VU Medical Center, Amsterdam, The Netherlands – sequence: 3 givenname: Hence J surname: Verhagen fullname: Verhagen, Hence J organization: Division of Vascular Surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands – sequence: 4 givenname: Jorg L surname: de Bruin fullname: de Bruin, Jorg L organization: Division of Vascular Surgery, Department of Surgery, VU Medical Center, Amsterdam, The Netherlands – sequence: 5 givenname: Marc R H M surname: van Sambeek fullname: van Sambeek, Marc R H M organization: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands – sequence: 6 givenname: Ron surname: Balm fullname: Balm, Ron organization: Division of Vascular Surgery, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands – sequence: 7 givenname: Clark J surname: Zeebregts fullname: Zeebregts, Clark J organization: Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands – sequence: 8 givenname: Joost A surname: van Herwaarden fullname: van Herwaarden, Joost A organization: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands – sequence: 9 givenname: Jan D surname: Blankensteijn fullname: Blankensteijn, Jan D email: j.blankensteijn@vumc.nl organization: Division of Vascular Surgery, Department of Surgery, VU Medical Center, Amsterdam, The Netherlands. Electronic address: j.blankensteijn@vumc.nl
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ContentType	Journal Article
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surname: Vermassen fullname: Vermassen, F E G
Copyright	Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
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PublicationTitle	Journal of vascular surgery
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References	29389438 - J Vasc Surg. 2018 Feb;67(2):683
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Snippet	Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up...
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SubjectTerms	Aged Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Belgium Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Cause of Death Disease-Free Survival Endovascular Procedures - adverse effects Endovascular Procedures - mortality Female Humans Intention to Treat Analysis Kaplan-Meier Estimate Male Middle Aged Netherlands Postoperative Complications - diagnostic imaging Postoperative Complications - mortality Postoperative Complications - therapy Retreatment Risk Factors Time Factors Treatment Outcome
Title	Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms
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