EVAR-1
UK Endovascular Aneurysm Repair Trial 1 — 15-year follow-up
Patient / Population Intervention / Exposition Vergleich Endpunkt
In 1,252 patients with a large asymptomatic abdominal aortic aneurysm fit for either procedure, endovascular aneurysm repair gave an early survival benefit but inferior late all-cause and aneurysm-related mortality compared with open surgical repair.
N
1.252
Design
Open-label RCT, 15-year follow-up
Endpunkt
Total and aneurysm-related mortality
Relevanz
2
ErgebnisOverall 9.3 vs 8.9 deaths per 100 person-years (HR 1.11; 95 % CI 0.97–1.27). EVAR favoured at 0–6 months, but beyond 8 years total mortality HR 1.25 (95 % CI 1.00–1.56) and aneurysm-related mortality HR 5.82 (95 % CI 1.64–20.65), mainly from secondary sac rupture.
Patel R, Sweeting MJ, et al. Lancet. 2016;388(10058):2366-2374. 10.1016/S0140-6736(16)31135-7
Diskussion & Kritik
The devices and surveillance imaging of 1999–2004 are two generations behind current practice, so the late-rupture signal may overstate the hazard of modern endografts. It is the definitive long-horizon randomised comparison and the explicit basis for demanding lifelong post-EVAR surveillance.