Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial

Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomiz...

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Main Authors: Braithwaite, B, Greenhalgh, R, Grieve, R, Hassan, T, Moore, F, Nicholson, A, Soong, C, Heatley, F, Anjum, A, Kalinowska, G, Gomes, M, Powell, J, Hinchliffe, R, Sweeting, M, Thompson, M, Thompson, S, Ulug, P, Roberts, I, Bell, P, Cheetham, A, Stephany, J, Warlow, C, Lamont, P, Moss, J, Tijssen, J, Ashleigh, R, Thompson, L, Cheshire, N, Boyle, JR, Serracino-Inglott, F, Bell, R, Wilson, N, Bown, M, Dennis, M, Davis, M, Howell, S, Wyatt, MG, Valenti, D, Bachoo, P, Walker, P, MacSweeney, S, Davies, J, Rittoo, D, Parvin, S, Yusuf, W, Nice, C, Chetter, I, Howard, A, Chong, P, Bhat, R, McLain, D, Gordon, A, Lane, I, Hobbs, S, Pillay, W, Rowlands, T, El-Tahir, A, Asquith, J, Cavanagh, S, Dubois, L, Forbes, T, Ashworth, E, Baker, S, Barakat, H, Brady, C, Brown, J, Bufton, C, Chance, T, Chrisopoulou, A, Cockell, M, Croucher, A, Dabee, L, Dewhirst, N, Evans, J, Gibson, A, Gorst, S, Gough, M, Graves, L, Griffin, M, Hatfield, J, Hogg, F, Howard, S, Hughes, C, Metcalfe, D, Lapworth, M, Massey, I, Novick, T, Owen, G, Parr, N, Pintar, D, Spencer, S, Thomson, C, Thunder, O, Wallace, T, Ward, S, Wealleans, V, Wilson, L, Woods, J
格式: Journal article
出版: Oxford University Press 2015
實物特徵
總結:Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI-0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or 4356 (95% CI 284, 8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective.

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