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As previously reported, endovascular repair of abdominal aortic aneurysms (AAAs) results in lower 30-day mortality than open surgical repair (JW Cardiol Nov 19 2004). In this report, the DREAM investigators present their long-term, multicenter findings involving 351 patients (mean age, 70; 92% men) with AAAs ≥5 cm in diameter.
Cumulative overall survival at 6 years was not significantly different between the open-repair and endovascular-repair groups (70% and 69%, respectively). The rate of reintervention after endovascular repair (including for endograft migration or endoleak) was higher than the rate of reintervention after surgery (30% vs. 18%; P=0.03). However, the increase in late mortality after endovascular repair was not directly attributable to these reinterventions.
De Bruin JL et al. for the DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010 May 20; 362:1881.
Comment
These findings confirm the recently published long-term results of EVAR 1 (JW Cardiol Apr 14 2010): The short-term benefit of endovascular repair of AAA is lost during long-term follow-up. Nonetheless, recent advances in endovascular devices, insertion techniques, and operator experience may affect future comparisons and are likely to influence both patient and physician preferences for one approach versus the other in individual situations.