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N Engl J Med. 2010 May 20;362(20):1863-71. doi: 10.1056/NEJMoa0909305. Epub 2010 Apr 11.

Endovascular versus open repair of abdominal aortic aneurysm.

Collaborators (176)

Greenhalgh RM, Allison DJ, Bell PR, Buxton MJ, Harris PL, Hopkinson BR, Powell JT, Russell IT, Thompson SG, Brown LC, Brown LC, Epstein D, Sculpher MJ, Thompson SG, Greenhalgh RM, Beard JD, Buxton MJ, Harris PL, Powell JT, Rose JD, Russell IT, Sculpher MJ, Thompson SG, Lilford RJ, Bell PR, Greenhalgh RM, Whitaker SC, Poole-Wilson PA, Ruckley CV, Campbell WB, Dean MR, Ruttley MS, Coles EC, Powell JT, Halliday A, Gibbs S, Dorricott HD, Varty K, Cousins C, Hannon RJ, Johnston L, Bradbury AW, Henderson MJ, Parvin SD, Shepherd DF, Greenhalgh RM, Mitchell AW, Edwards PR, Abbott GT, Higman DJ, Vohra A, Ashley S, Robottom C, Wyatt MG, Rose JD, Byrne D, Edwards R, Leiberman DP, McCarter DH, Taylor PR, Reidy JF, Wilkinson AR, Ettles DF, Clason AE, Leen GL, Wilson NV, Downes M, Walker SR, Lavelle JM, Gough MJ, McPherson S, Scott DJ, Kessell DO, Naylor R, Sayers R, Fishwick NG, Harris PL, Gould DA, Walker MG, Chalmers NC, Garnham A, Collins MA, Beard JD, Gaines PA, Ashour MY, Uberoi R, Braithwaite B, Whitaker SC, Davies JN, Travis S, Hamilton G, Platts A, Shandall A, Sullivan BA, Sobeh M, Matson M, Fox AD, Orme R, Yusef W, Doyle T, Horrocks M, Hardman J, Blair PH, Ellis PK, Morris G, Odurny A, Vohra R, Duddy M, Thompson M, Loosemore TM, Belli AM, Morgan R, Adiseshiah M, Brookes JA, McCollum CN, Ashleigh R, Aukett M, Baker S, Barbe E, Batson N, Bell J, Blundell J, Boardley D, Boyes S, Brown O, Bryce J, Carmichael M, Chance T, Coleman J, Cosgrove C, Curran G, Dennison T, Devine C, Dewhirst N, Errington B, Farrell H, Fisher C, Fulford P, Gough M, Graham C, Hooper R, Horne G, Horrocks L, Hughes B, Hutchings T, Ireland M, Judge C, Kelly L, Kemp J, Kite A, Kivela M, Lapworth M, Lee C, Linekar L, Mahmood A, March L, Martin J, Matharu N, McGuigen K, Morris-Vincent P, Murray S, Murtagh A, Owen G, Ramoutar V, Rippin C, Rowley J, Sinclair J, Spencer S, Taylor V, Tomlinson C, Ward S, Wealleans V, West J, White K, Williams J, Wilson L.



Few data are available on the long-term outcome of endovascular repair of abdominal aortic aneurysm as compared with open repair.


From 1999 through 2004 at 37 hospitals in the United Kingdom, we randomly assigned 1252 patients with large abdominal aortic aneurysms (> or = 5.5 cm in diameter) to undergo either endovascular or open repair; 626 patients were assigned to each group. Patients were followed for rates of death, graft-related complications, reinterventions, and resource use until the end of 2009. Logistic regression and Cox regression were used to compare outcomes in the two groups.


The 30-day operative mortality was 1.8% in the endovascular-repair group and 4.3% in the open-repair group (adjusted odds ratio for endovascular repair as compared with open repair, 0.39; 95% confidence interval [CI], 0.18 to 0.87; P=0.02). The endovascular-repair group had an early benefit with respect to aneurysm-related mortality, but the benefit was lost by the end of the study, at least partially because of fatal endograft ruptures (adjusted hazard ratio, 0.92; 95% CI, 0.57 to 1.49; P=0.73). By the end of follow-up, there was no significant difference between the two groups in the rate of death from any cause (adjusted hazard ratio, 1.03; 95% CI, 0.86 to 1.23; P=0.72). The rates of graft-related complications and reinterventions were higher with endovascular repair, and new complications occurred up to 8 years after randomization, contributing to higher overall costs.


In this large, randomized trial, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower operative mortality than open surgical repair. However, no differences were seen in total mortality or aneurysm-related mortality in the long term. Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly. (Current Controlled Trials number, ISRCTN55703451.)

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