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Ruptured Abdominal Aortic Aneurysm pp 259–271Cite as

Randomized Trials: What is the Evidence?

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Abstract

Endovascular surgery for ruptured abdominal aortic aneurysms (rAAA) was first described in 1994, but only recently has there been robust evidence to support it as a definite alternative to open surgical repair. Randomized controlled trial evidence comes in the form of the AJAX, ECAR, and IMPROVE trials, with the latter mirroring current clinical practice most closely. IMPROVE has shown that endovascular surgery for rAAA is as effective as open surgical repair, allows for shorter hospital stays, offers a greater advantage for women, and is cost-effective, and these results have been borne out in an individual patient meta-analysis of all three studies. It is vital in the modern era that centers offering repair of rAAA should offer both open surgical and endovascular approaches to patients appropriately. Analysis of results with reference to aortic morphology has demonstrated that the biggest future gains in mortality are likely to occur in patients with short aortic necks, and this is an area that should be the focus of development in open and endovascular repair.

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Notes

  1. 1.

    Four patients in the Endovascular Strategy group had an attempt at EVAR, but required conversion to open repair. All 4 died within 30 days. These 4 patients were included in the EVAR deaths but not in the open repair deaths in the Endovascular Strategy group calculations. However, in the calculations of the overall 30-day mortality rates for the two randomized groups taken together, these 4 patients were excluded from the EVAR deaths and included in the open repair deaths. If these 4 patients were included in the EVAR deaths and excluded from the open repair deaths in the calculations for the combined groups, the 30-day mortalities would have been 26.3 % (50/190) for EVAR and 37.3 % (124/332) for open repair (p = 0.01).

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Authors and Affiliations

  1. St George’s Vascular Institute, St George’s Hospital, Blackshaw Road Tooting, London, SW17 0QT, UK

    James Budge, Benjamin Patterson & Matt M. Thompson MD

  2. New York University, Langone Medical Center, New York, NY, USA

    Frank J. Veith MD & Caron B. Rockman MD

  3. The Cleveland Clinic, Cleveland, OH, USA

    Frank J. Veith MD

Authors
  1. James Budge
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  2. Benjamin Patterson
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  3. Matt M. Thompson MD
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  4. Frank J. Veith MD
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  5. Caron B. Rockman MD
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Corresponding authors

Correspondence to Matt M. Thompson MD , Matt Thompson or Frank J. Veith and MD .

Editor information

Editors and Affiliations

  1. Division of Vascular Surgery, University of Washington Harborview Medical Center, Seattle, Washington, USA

    Benjamin W. Starnes

  2. Albany Medical Center, Albany, New York, USA

    Manish Mehta

  3. Bronx, New York, USA

    Frank J. Veith

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Budge, J., Patterson, B., Thompson, M.M., Veith, F.J., Rockman, C.B. (2017). Randomized Trials: What is the Evidence?. In: Starnes, B., Mehta, M., Veith, F. (eds) Ruptured Abdominal Aortic Aneurysm. Springer, Cham. https://doi.org/10.1007/978-3-319-23844-9_14

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  • DOI: https://doi.org/10.1007/978-3-319-23844-9_14

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