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.
“We are playing the same sport, but a different game,” the wise, thoughtful emergency medicine attending physician once told me. “I am playing speed chess – I need to make a move quickly, or I lose – no matter what. My moves have to be right, but they don’t always necessarily need to be the […]
With great successes in hosting our first couple of Twitter chats over the last six months, we’re excited to bring you the third in our quarterly series, #JHMChat, where you ask Journal of Hospital Medicine (JHM) authors about their research and corresponding clinical implications for managing inpatient care. We invite you to join us for […]
Kurt Pfeifer, MD, FACP, FHM Does the phrase “medical clearance” make your skin crawl? Perioperative medicine continues to be a growing part of the practice of hospitalists everywhere, yet for many this is an area they feel uncomfortable with. Never fear! Hospital Medicine 2016 has more perioperative medicine educational offerings than ever! On Sunday, March […]