Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial
<p><strong>Objective:</strong> The aim of the study was to compare long-term total and aneurysm-related mortality in physically frail patients with abdominal aortic aneurysm (AAA) randomized to either early endovascular aneurysm repair (EVAR) or no-intervention.</p> <p>...
| Main Authors: | , , , , |
|---|---|
| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams and Wilkins
2017
|
| _version_ | 1797100079554756608 |
|---|---|
| author | Sweeting, M Patel, R Powell, J Greenhalgh, R for the EVAR Trial Investigators |
| author2 | Halliday, A |
| author_facet | Halliday, A Sweeting, M Patel, R Powell, J Greenhalgh, R for the EVAR Trial Investigators |
| author_sort | Sweeting, M |
| collection | OXFORD |
| description | <p><strong>Objective:</strong> The aim of the study was to compare long-term total and aneurysm-related mortality in physically frail patients with abdominal aortic aneurysm (AAA) randomized to either early endovascular aneurysm repair (EVAR) or no-intervention.</p> <p><strong>Summary Background Data:</strong> EVAR-2 remains the sole randomized trial to identify whether EVAR reduces mortality in patients physically ineligible for open repair.</p> <p><strong>Methods:</strong> Between September 1999 and August 2004, 404 patients from 33 centers in the United Kingdom aged ≥60 years with AAA >5.5 cm in diameter were randomized 1:1 using computer-generated sequences of randomly permuted blocks stratified by center to receive either EVAR (197) or no-intervention (207). The primary analysis compared total and aneurysm-related deaths in groups until June 30, 2015 (mean, 12.0 yrs; maximum 14.1 yrs).</p> <p><strong>Results:</strong> Mean follow-up until death or censoring was 4.2 years. There were 187 deaths (22.6 per 100 person-yrs) in the EVAR group and 194 (22.1 per 100 person-yrs) in the no-intervention group. By 12 years of follow-up the estimated survival was 5.3% [95% confidence interval (CI), 2.6–9.2] in the EVAR group and 8.5% (95% CI, 5.2–12.9) in the no-intervention group; there was no significant difference in life expectancy between the groups (both 4.2 yrs; P = 0.97). However, overall aneurysm-related mortality was significantly lower in the EVAR group [3.3 deaths per 100 person-yrs compared with 6.5 deaths per 100 person-yrs in the no-intervention group, adjusted hazard ratio 0.55 (95% CI, 0.34–0.91; P = 0.019)]. Patients surviving beyond 8 years were younger, with higher body mass index, estimated glomerular filtration rate, and forced expiratory volume in 1 second.</p> <p><strong>Conclusions:</strong> EVAR does not increase overall life expectancy in patients ineligible for open repair, but can reduce aneurysm-related mortality.</p> |
| first_indexed | 2024-03-07T05:32:42Z |
| format | Journal article |
| id | oxford-uuid:e2d16784-f837-451e-9c02-05da70d74900 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:32:42Z |
| publishDate | 2017 |
| publisher | Lippincott, Williams and Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:e2d16784-f837-451e-9c02-05da70d749002022-03-27T10:04:16ZEndovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e2d16784-f837-451e-9c02-05da70d74900EnglishSymplectic Elements at OxfordLippincott, Williams and Wilkins2017Sweeting, MPatel, RPowell, JGreenhalgh, Rfor the EVAR Trial InvestigatorsHalliday, A<p><strong>Objective:</strong> The aim of the study was to compare long-term total and aneurysm-related mortality in physically frail patients with abdominal aortic aneurysm (AAA) randomized to either early endovascular aneurysm repair (EVAR) or no-intervention.</p> <p><strong>Summary Background Data:</strong> EVAR-2 remains the sole randomized trial to identify whether EVAR reduces mortality in patients physically ineligible for open repair.</p> <p><strong>Methods:</strong> Between September 1999 and August 2004, 404 patients from 33 centers in the United Kingdom aged ≥60 years with AAA >5.5 cm in diameter were randomized 1:1 using computer-generated sequences of randomly permuted blocks stratified by center to receive either EVAR (197) or no-intervention (207). The primary analysis compared total and aneurysm-related deaths in groups until June 30, 2015 (mean, 12.0 yrs; maximum 14.1 yrs).</p> <p><strong>Results:</strong> Mean follow-up until death or censoring was 4.2 years. There were 187 deaths (22.6 per 100 person-yrs) in the EVAR group and 194 (22.1 per 100 person-yrs) in the no-intervention group. By 12 years of follow-up the estimated survival was 5.3% [95% confidence interval (CI), 2.6–9.2] in the EVAR group and 8.5% (95% CI, 5.2–12.9) in the no-intervention group; there was no significant difference in life expectancy between the groups (both 4.2 yrs; P = 0.97). However, overall aneurysm-related mortality was significantly lower in the EVAR group [3.3 deaths per 100 person-yrs compared with 6.5 deaths per 100 person-yrs in the no-intervention group, adjusted hazard ratio 0.55 (95% CI, 0.34–0.91; P = 0.019)]. Patients surviving beyond 8 years were younger, with higher body mass index, estimated glomerular filtration rate, and forced expiratory volume in 1 second.</p> <p><strong>Conclusions:</strong> EVAR does not increase overall life expectancy in patients ineligible for open repair, but can reduce aneurysm-related mortality.</p> |
| spellingShingle | Sweeting, M Patel, R Powell, J Greenhalgh, R for the EVAR Trial Investigators Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial |
| title | Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial |
| title_full | Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial |
| title_fullStr | Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial |
| title_full_unstemmed | Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial |
| title_short | Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: Very long-term follow-up in the EVAR-2 randomized controlled trial |
| title_sort | endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair very long term follow up in the evar 2 randomized controlled trial |
| work_keys_str_mv | AT sweetingm endovascularrepairofabdominalaorticaneurysminpatientsphysicallyineligibleforopenrepairverylongtermfollowupintheevar2randomizedcontrolledtrial AT patelr endovascularrepairofabdominalaorticaneurysminpatientsphysicallyineligibleforopenrepairverylongtermfollowupintheevar2randomizedcontrolledtrial AT powellj endovascularrepairofabdominalaorticaneurysminpatientsphysicallyineligibleforopenrepairverylongtermfollowupintheevar2randomizedcontrolledtrial AT greenhalghr endovascularrepairofabdominalaorticaneurysminpatientsphysicallyineligibleforopenrepairverylongtermfollowupintheevar2randomizedcontrolledtrial AT fortheevartrialinvestigators endovascularrepairofabdominalaorticaneurysminpatientsphysicallyineligibleforopenrepairverylongtermfollowupintheevar2randomizedcontrolledtrial |