The ACE trial: A randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm

Endovascular repair of infrarenal abdominal aneurysms (EVAR) is currently used in patients with large aneurysm. Two randomized studies, Dutch Randomised Endovascular Aneurysm Management (DREAM) and Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR-1), showed favorable early results with EVAR; but at 2 and 4 years, the rates of all-cause mortalities were no longer different. Patients in EVAR groups required more reinterventions. These data were confirmed by national audits and large registries. However, there is still uncertainty concerning the durability of the devices, and long-term results are unknown. The ACE (Anevrysme de Paorte abdominale, Chirurgie versus Endoprothese) trial is a multicenter, prospective randomized trial aimed at assessing the results of EVAR and of open surgery in relatively good-risk patients presenting with an asymptomatic abdominal aortic or aortoiliac aneurysm. The primary end point is death and major complications up to 5 years after randomization. Analysis of results is underway, and publication due by the end of the year. (J Vasc Surg 2009;50:222-4.)