A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms

被引:1531
作者
Prinssen, M
Verhoeven, ELG
Buth, J
Cuypers, PWM
van Sambeek, MRHM
Balm, R
Buskens, E
Grobbee, DE
Blankensteijn, JD
Grobbee, DE
Blankensteijn, JD
Buth, J
Pattynama, PM
Verhoeven, ELG
van Voorthuisen, AE
Bak, AAA
Blankensteijn, JD
Prinssen, M
van Sambeek, MRHM
Verhoeven, ELG
Buth, J
Cuypers, PWM
Balm, R
Buskens, E
Grobbee, DE
Hunink, MG
van Engelshoven, JM
Jacobs, MJHM
de Mol, BAJM
van Bockel, JH
Balm, R
Reekers, J
Tielbeek, X
Verhoeven, ELG
Wisselink, W
Boekema, N
Sikking, I
Prinssen, M
Balm, R
Buth, J
van Sambeek, MRHM
Verhoeven, ELG
Blankensteijn, JD
Blankensteijn, JD
Prinssen, M
Buskens, E
Buth, J
Tielbeek, AV
Blankensteijn, JD
Balm, R
机构
[1] Univ Med Ctr, Dept Surg, Div Vasc Surg, Utrecht, Netherlands
[2] Univ Med Ctr, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands
[3] Univ Groningen, Univ Med Ctr Groningen, Acad Hosp, Dept Surg, Div Vasc Surg, Groningen, Netherlands
[4] Catharina Hosp, Dept Surg, Eindhoven, Netherlands
[5] Erasmus MC, Dept Surg, Div Vasc Surg, Rotterdam, Netherlands
[6] Univ Amsterdam, Acad Med Ctr, Dept Surg, Div Vasc Surg, NL-1105 AZ Amsterdam, Netherlands
[7] Radboud Univ Nijmegen, Nijmegen Med Ctr, Dept Vasc Surg, NL-6500 HB Nijmegen, Netherlands
关键词
D O I
10.1056/NEJMoa042002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Although the initial results of endovascular repair of abdominal aortic aneurysms were promising, current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair. METHODS: We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. The outcome events analyzed were operative (30-day) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications. RESULTS: The operative mortality rate was 4.6 percent in the open-repair group (8 of 174 patients; 95 percent confidence interval, 2.0 to 8.9 percent) and 1.2 percent in the endovascular-repair group (2 of 171 patients; 95 percent confidence interval, 0.1 to 4.2 percent), resulting in a risk ratio of 3.9 (95 percent confidence interval, 0.9 to 32.9). The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group (17 of 174 patients; 95 percent confidence interval, 5.8 to 15.2 percent) and 4.7 percent in the endovascular-repair group (8 of 171 patients; 95 percent confidence interval, 2.0 to 9.0 percent), resulting in a risk ratio of 2.1 (95 percent confidence interval, 0.9 to 5.4). CONCLUSIONS: On the basis of the overall results of this trial, endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter. Long-term follow-up is needed to determine whether this advantage is sustained.
引用
收藏
页码:1607 / 1618
页数:12
相关论文
共 33 条
[1]   Elective endovascular versus open surgical repair of abdominal aortic aneurysms: Systematic review of short-term results [J].
Adriaensen, MEAPM ;
Bosch, JL ;
Halpern, EF ;
Hunink, MGM ;
Gazelle, GS .
RADIOLOGY, 2002, 224 (03) :739-747
[2]   The impact of endovascular treatment on in-hospital mortality following non-ruptured AAA repair over a decade: A population based study of 16,446 patients [J].
Akkersdijk, GJM ;
Prinssen, M ;
Blankensteijn, JD .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2004, 28 (01) :41-46
[3]   A statewide experience with endovascular abdominal aortic aneurysm repair: Rapid diffusion with excellent early results - Discussion [J].
Matsumura, JS ;
Anderson, PL ;
Muluk, SC ;
Green, RM ;
Dardik, A ;
Ricotta, JJ .
JOURNAL OF VASCULAR SURGERY, 2004, 39 (01) :18-19
[4]  
Blankensteijn JD, 1998, BRIT J SURG, V85, P1624
[5]  
Bolland K, 2000, STAT MED, V19, P2899, DOI 10.1002/1097-0258(20001115)19:21<2899::AID-SIM597>3.0.CO
[6]  
2-O
[7]   Abdominal aortic aneurysms: Cost-effectiveness of elective endovascular and open surgical repair [J].
Bosch, JL ;
Kaufman, JA ;
Beinfeld, MT ;
Adriaensen, MEAPM ;
Brewster, DC ;
Gazelle, GS .
RADIOLOGY, 2002, 225 (02) :337-344
[8]  
Brady AR, 2002, NEW ENGL J MED, V346, P1445
[9]   Guidelines for the treatment of abdominal aortic aneurysms - Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery [J].
Brewster, DC ;
Cronenwett, JL ;
Hallett, JW ;
Johnston, KW ;
Krupski, WC ;
Matsumura, JS .
JOURNAL OF VASCULAR SURGERY, 2003, 37 (05) :1106-1117
[10]   Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair [J].
Carpenter, JP ;
Baum, RA ;
Barker, CF ;
Golden, MA ;
Mitchell, ME ;
Velazquez, OC ;
Fairman, RM .
JOURNAL OF VASCULAR SURGERY, 2001, 34 (06) :1050-1054