1. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms
- Author
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Theodorus G. van Schaik, Kak K. Yeung, Hence J. Verhagen, Jorg L. de Bruin, Marc R.H.M. van Sambeek, Ron Balm, Clark J. Zeebregts, Joost A. van Herwaarden, Jan D. Blankensteijn, D.E. Grobbee, J.D. Blankensteijn, A.A.A. Bak, J. Buth, P.M. Pattynama, E.L.G. Verhoeven, A.E. van Voorthuisen, R. Balm, P.W.M. Cuypers, M. Prinssen, M.R.H.M. van Sambeek, A.F. Baas, M.G. Hunink, J.M. van Engelshoven, M.J.H.M. Jacobs, B.A.J.M. de Mol, J.H. van Bockel, J. Reekers, X. Tielbeek, W. Wisselink, N. Boekema, L.M. Heuveling, I. Sikking, J.L. de Bruin, A.V. Tielbeek, J.A. Reekers, P. Pattynama, T. Prins, A.C. van der Ham, J.J.I.M. van der Velden, S.M.M. van Sterkenburg, G.B. ten Haken, C.M.A. Bruijninckx, H. van Overhagen, R.P. Tutein Nolthenius, T.R. Hendriksz, J.A.W. Teijink, H.F. Odink, A.A.E.A. de Smet, D. Vroegindeweij, R.M.M. van Loenhout, M.J. Rutten, J.F. Hamming, L.E.H. Lampmann, M.H.M. Bender, H. Pasmans, A.C. Vahl, C. de Vries, A.J.C. Mackaay, L.M.C. van Dortmont, A.J. van der Vliet, L.J. Schultze Kool, J.H.B. Boomsma, H.R. van Dop, J.C.A. de Mol van Otterloo, T.P.W. de Rooij, T.M. Smits, E.N. Yilmaz, F.G. van den Berg, M.J.T. Visser, E. van der Linden, G.W.H. Schurink, M. de Haan, H.J. Smeets, P. Stabel, F. van Elst, J. Poniewierski, F.E.G. Vermassen, Cardiovascular Biomechanics, Surgery, ACS - Amsterdam Cardiovascular Sciences, Cardiothoracic Surgery, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias, Man, Biomaterials and Microbes (MBM), Vascular Ageing Programme (VAP), Amsterdam Gastroenterology Endocrinology Metabolism, and ACS - Microcirculation
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Postoperative Complications/diagnostic imaging ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Endovascular aneurysm repair ,law.invention ,Aortic aneurysm ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,Belgium ,law ,Risk Factors ,Cause of Death ,030212 general & internal medicine ,Cause of death ,Netherlands ,OUTCOMES ,Endovascular Procedures ,II ENDOLEAK ,Middle Aged ,RANDOMIZED CONTROLLED-TRIAL ,Abdominal aortic aneurysm ,Aortic Aneurysm ,Intention to Treat Analysis ,Treatment Outcome ,Retreatment ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Abdominal/diagnostic imaging ,Disease-Free Survival ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,Aneurysm ,medicine ,Humans ,Endovascular Procedures/adverse effects ,cardiovascular diseases ,EXPOSURE ,Blood Vessel Prosthesis Implantation/adverse effects ,Aged ,Intention-to-treat analysis ,business.industry ,medicine.disease ,Surgery ,RADIATION ,business ,FOLLOW-UP ,Abdominal surgery ,Aortic Aneurysm, Abdominal ,Aortic Aneurysm, Abdominal/diagnostic imaging - Abstract
Item does not contain fulltext OBJECTIVE: Randomized trials have shown an initial survival benefit of endovascular over conventional open abdominal aortic aneurysm repair but no long-term difference up to 6 years after repair. Longer follow-up may be required to demonstrate the cumulative negative impact on survival of higher reintervention rates associated with endovascular repair. METHODS: We updated the results of the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, a multicenter, randomized controlled trial comparing open with endovascular aneurysm repair, up to 15 years of follow-up. Survival and reinterventions were analyzed on an intention-to-treat basis. Causes of death and secondary interventions were compared by use of an events per person-year analysis. RESULTS: There were 178 patients randomized to open and 173 to endovascular repair. Twelve years after randomization, the cumulative overall survival rates were 42.2% for open and 38.5% for endovascular repair, for a difference of 3.7 percentage points (95% confidence interval, -6.7 to 14.1; P = .48). The cumulative rates of freedom from reintervention were 78.9% for open repair and 62.2% for endovascular repair, for a difference of 16.7 percentage points (95% confidence interval, 5.8-27.6; P = .01). No differences were observed in causes of death. Cardiovascular and malignant disease account for the majority of deaths after prolonged follow-up. CONCLUSIONS: During 12 years of follow-up, there was no survival difference between patients who underwent open or endovascular abdominal aortic aneurysm repair, despite a continuously increasing number of reinterventions in the endovascular repair group. Endograft durability and the need for continued endograft surveillance remain key issues.
- Published
- 2017
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