In this multi-center trial of >1200 patients with large (>5.5cm) AAAs, they were randomized to elective repair by open or endovascular techniques. 30 day death was significantly lower in the endovascular group (1.8% vs 4.3%) but there was no difference in all-cause mortality by the end of follow-up between the groups. The endovascular group had higher rates of complications and re-interventions, and higher overall cost (abstract). This study is consistent with the recently published EVAR-1 Trial (link) which found in patients ineligible for open repair, endovascular repair was associated with lower aneurysm-related death, but there was no benefit to all-cause mortality. Type of AAA repair will likely be driven by patient-specific and physician preferences, and life expectancy.
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