Results of endovascular aneurysm repair trials published
Significant findings from two UK clinical trials targeting the third biggest cause of sudden death in Britain suggest that the initial benefits of a new minimally invasive surgical technique are maintained at four years for low risk patients. However, for high risk patients – for whom the technique was designed in the first place – endovascular aneurysm repair offers no benefit.
Results of the £1.7 million endovascular aneurysm repair (EVAR) trials, commissioned by the NHS Health Technology Assessment (HTA) programme and published in the renowned international medical journal The Lancet on 17 June 2005 show that the 3% operative mortality benefit of EVAR over open repair (OR) is maintained in this four year follow-up. In contrast to OR, which imposes a significant period of recovery in intensive care, EVAR can be carried out under local anaesthetic with a very much shorter hospital stay. However, EVAR is a developing technology and is associated with increased surveillance needs, NHS costs and the risk of further procedures, including conversion to OR.
In the high risk patients for whom EVAR was originally developed – people who were unfit for an OR – there was no demonstrable benefit in terms of either mortality or quality of life, and 7% of patients died in the first 30 days after the elective operation.
“The EVAR trial results will affect clinical practice at once,” said Professor Greenhalgh, lead applicant and chair of the Trial Management Committee. “There will be cautious enthusiasm for the use of EVAR in low risk patients but personally I shall not offer EVAR in high risk patients.”