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JAMA. 2009 Oct 14;302(14):1535-42. doi: 10.1001/jama.2009.1426.

Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial.

Collaborators (295)

Ketteler ER, Kingsley DD, Marek JM, Massen RJ, Matteson BD, Pitcher JD, Langsfeld M, Corson JD, Goff JM Jr, Kasirajan K, Paap C, Robertson DC, Veeraswamy R, Milner R, Salam A, Kasirajan K, Guidot J, Busuttil S, Lilly MP, Braganza M, Ellis K, Patterson MA, Jordon WD, Whitley D, Taylor S, Passman M, Kerns D, Inman C, Poirier J, Ebaugh J, Raffetto J, Chew D, Lathi S, Owens C, Hickson K, Dosluoglu HH, Eschberger K, Kibbe MR, Baraniewski HM, Matsumura J, Busman A, Meadows W, Evans M, El Sayed H, Reed AB, Giglia JS, Ross S, Ruf M, Jean-Claude JM, Pinault G, Kang P, White N, Eiseman M, Jones R, Modrall JG, Timaran CH, Welborn MB 3rd, Lopez J, Nguyen T, Chacko JK, Granke K, Vouyouka AG, Olgren E, Chand P, Allende B, Ranella M, Yales C, Whitehill TA, Krupski WC, Nehler MR, Johnson SP, Jones DN, Strecker P, Bhola MA, Shortell CK, Gray JL, Lawson JH, Sebastian MW, Kistler Tetterton J, Blackwell C, Prinzo PA, Lee N, Padberg FT Jr, Cerveira JJ, Lal BK, Zickler RW, Hauck KA, Berceli SA, Lee WA, Ozaki CK, Nelson PR, Irwin AS, Baum R, Aulivola B, Rodriguez H, Littooy FN, Greislev H, O'Sullivan MT, Lin PH, Bush RL, Kougias P, Guinn G, Cagiannos C, Pillack S, Guillory B, Cikrit D, Lalka SG, Nachreiner R, Rusomaroff M, O'Brien E, Hoballah J, Sharp WJ, McCandless JL, Beach V, Minion D, Schwarcz TH, Kimbrough J, Ashe L, Rockich A, Warner-Carpenter J, Moursi M, Eidt JF, Brock S, Bianchi C, Bishop V, Gordon IL, Fujitani R, Kubaska SM 3rd, Azadegan R, Ma Agas C, Zalecki K, Hoch JR, Carr SC, Acher C, Schwarze M, Tefera G, Mell M, Rieder J, Stuart JM, Weiman DS, Abul-Khoudoud O, Garrett HE, Walsh SM, Wilson KL, Seabrook GR, Cambria RA, Brown KR, Lewis B, Framberg S, Kallio C, Barke RA, Santilli SM, d'Audiffret AC, Oberle N, Proebstle C, Johnson LL, Jacobowitz GR, Cayne N, Rockman C, Adelman M, Gagne P, Nalbandian M, Caropolo LJ, Pipinos II, Johanning J, Lynch T, DeSpiegelaere H, Purviance G, Zhou W, Dalman R, Lee JT, Safadi B, Coogan SM, Wren SM, Bahmani D, Maples D, Thunen S, Golden MA, Mitchell ME, Fairman R, Reinhardt S, Wilson MA, Tzeng E, Muluk S, Peterson NM, Foster M, Edwards J, Moneta GL, Landry G, Taylor L, Yeager R, Cannady E, Treiman G, Hatton-Ward S, Salabsky B, Rapp JH, Reilly LM, Sarkar R, Dwyer SS, Kohler TR, Hatsukami TS, Glickerman DG, Sobel M, Burdick TS, Pedersen K, Cleary P, Kansal N, Kumins NH, Estes M, Forbes BA, Sobotta C, Back M, Bandyk D, Johnson B, Shames M, Reinhard RL, Thomas SC, Leon LR Jr, Westerband A, Guerra RJ, Riveros M, Mills JL, Hughes JD, Psalms SB, Day NN, Sidawy A, Weiswasser JM, Arora S, Jasper BJ, Dardik A, Gahtan V, Muhs BE, Sumpio BE, Gusberg RJ, Spector M, Pollak J, Aruny J, Kelly EL, Wong J, Vasilas P, Joncas C, Gelabert HA, DeVirgillio C, Rigberg DA, Cole L, Lederle FA, Freischlag JA, Kohler TR, Matsumura J, Padberg FT Jr, Kyriakides TC, Swanson KM, Thornton J, Jonk Y, Stroupe KT, Peduzzi P, Antonelli M, Cushing C, Durant L, Joyner S, Kyriakides TC, LeGwin M, O'Connor T, Zellner S, McBride V, Stratton S, Davis E, Kossack A, Poulton J, Swanson KM, Thornton J, Haakenson CM, Stroupe KT, Jonk Y, Marottoli R, Kasl S, Mehta R, Feldman R, Farrell W, Allore H, Perry E, Niederman J, Sister Frances Randall, Reverend Michael Zeman, Beckwith D, Latts E, Bader M, O'Leary TJ, Huang GD, Hallett J, Hertzer N, Towne J, Katz DA, Karrison T, Matts JP.

Author information

  • 1Medicine Service, Veterans Affairs Medical Center, Minneapolis, Minnesota 55417, USA. frank.lederle@va.gov

Abstract

CONTEXT:

Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm (AAA) improves short-term outcomes compared with traditional open repair.

OBJECTIVE:

To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial.

DESIGN, SETTING, AND PATIENTS:

A randomized, multicenter clinical trial of 881 veterans (aged > or = 49 years) from 42 Veterans Affairs Medical Centers with eligible AAA who were candidates for both elective endovascular repair and open repair of AAA. The trial is ongoing and this report describes the period between October 15, 2002, and October 15, 2008.

INTERVENTION:

Elective endovascular (n = 444) or open (n = 437) repair of AAA.

MAIN OUTCOME MEASURES:

Procedure failure, secondary therapeutic procedures, length of stay, quality of life, erectile dysfunction, major morbidity, and mortality.

RESULTS:

Mean follow-up was 1.8 years. Perioperative mortality (30 days or inpatient) was lower for endovascular repair (0.5% vs 3.0%; P = .004), but there was no significant difference in mortality at 2 years (7.0% vs 9.8%, P = .13). Patients in the endovascular repair group had reduced median procedure time (2.9 vs 3.7 hours), blood loss (200 vs 1000 mL), transfusion requirement (0 vs 1.0 units), duration of mechanical ventilation (3.6 vs 5.0 hours), hospital stay (3 vs 7 days), and intensive care unit stay (1 vs 4 days), but required substantial exposure to fluoroscopy and contrast. There were no differences between the 2 groups in major morbidity, procedure failure, secondary therapeutic procedures, aneurysm-related hospitalizations, health-related quality of life, or erectile function.

CONCLUSIONS:

In this report of short-term outcomes after elective AAA repair, perioperative mortality was low for both procedures and lower for endovascular than open repair. The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair. Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00094575.

Comment in

PMID:
19826022
[PubMed - indexed for MEDLINE]
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