From the Guidelines
EVAR offers a significant survival benefit compared to no surgery for AAA patients, with a reduction in aneurysm-related mortality of approximately 45% (hazard ratio, 0.55; 95% CI, 0.34–0.91) as shown in the EVAR-2 trial 1. The survival benefit of Endovascular Aneurysm Repair (EVAR) compared to no surgery for Abdominal Aortic Aneurysm (AAA) patients is a crucial consideration in the management of this condition.
- Key points to consider include:
- The EVAR-2 trial, which evaluated outcomes of EVAR in high-risk patients, initially showed no improvement in survival compared to no intervention, but long-term follow-up revealed a significant reduction in aneurysm-related mortality 1.
- Contemporary analyses have demonstrated a marked decrease in perioperative death after EVAR, from 9% in the EVAR-2 trial to 1.9% in the ACS national registry 1.
- EVAR has been shown to reduce the risk of postoperative complications, such as myocardial infarction, pneumonia, acute renal failure, and need for dialysis, compared to open repair 1.
- The use of risk calculators, such as those derived from the Vascular Quality Initiative and the Vascular Study Group of New England, can help identify patients who are at high risk for elective AAA repair and may benefit from EVAR 1.
- Overall, the evidence suggests that EVAR provides a significant survival benefit for AAA patients, particularly those with high-risk features or large aneurysms, and should be considered as a treatment option in these cases.
From the Research
Survival Benefit of EVAR Compared to No Surgery
- The survival benefit of Endovascular Aneurysm Repair (EVAR) compared to no surgery for Abdominal Aortic Aneurysm (AAA) patients is a topic of interest in the medical field.
- According to the study by 2, EVAR offers a significant long-term reduction in AAA-related mortality, but this does not appear to influence all-cause mortality in patients unfit for open repair.
- The study found that during a total of 1413 person-years of follow-up, a total of 305 deaths occurred (78 AAA related) in EVAR trial 2, and the EVAR group demonstrated a significant advantage in terms of AAA-related mortality, but this became apparent only after 4 years.
Comparison of EVAR and Open Repair
- The study by 3 compared EVAR with open repair in patients with large AAAs and found that EVAR reduced the 30-day operative mortality by two-thirds compared with open repair.
- However, the study by 4 found that compared with open repair, EVAR offers no advantage with respect to all-cause mortality and health-related quality of life, is more expensive, and leads to a greater number of complications and reinterventions.
- The study by 5 examined the initial 10-year experience in one center when both EVAR and open repair techniques were available and found that there were no differences in early or long-term survival between open repair and EVAR.
Medical Management of Patients Undergoing EVAR
- The study by 6 reviewed the current literature on the medical treatment of patients undergoing EVAR, focusing on peri-operative management, anti-platelet agents, and statins.
- The study found that medical management of patients undergoing EVAR is required for several different reasons, including the increased risk of cardiovascular death and the need to prevent complications such as graft thrombosis and cardiovascular events.