Risk for Rupture Continues for Years After Endovascular Abdominal Aortic Aneurysm Repair

In multiple randomized trials, endovascular repair of abdominal aortic aneurysms (AAAs) has resulted in fewer deaths than open repair in the first 30 days after surgery. However, this mortality advantage is lost after 1 to 5 years, largely owing to later graft failure. About 15 years ago, researchers in the U.K. randomized 1252 patients (mean age, 74; 91% men) with large AAAs (≥5.5 cm in diameter) to open or endovascular repair (EVAR-1; NEJM JW Gen Med Aug 1 2005 and Lancet 2005; 365:2179). More patients died in the first 6 months after open repair than after endovascular repair, but after 10 years of follow-up, overall aneurysm-related and all-cause mortality were similar in both groups (NEJM JW Gen Med May 15 2010 and N Engl J Med 2010; 3…