Where to refer a AAA for repair?

The long term benefit of open versus endovascular repair of AAA is undetermined. In this trial of 1252 patients with large AAA’s (>5.5cm), they were randomized to open or endovascular repair (EVAR-1 Trial link). Short term mortality was significantly lower in the endovascular group (2% vs 4%), but long term mortality was the same between the groups. In addition, the endovascular group had higher rates of endovascular graft complications, re-interventions, and overall cost. A related trial (EVAR-2 trial link) randomized 404 patients ineligible for surgery, to endovascular repair versus no procedure. They found long-term overall mortality was the same between the groups, with the endovascular repair group costing significantly more than the no procedure group. Although initially appealing, endovascular repair of AAA’s does not reduce long term mortality, and increases long term cost of care.

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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