Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms

Theodorus G. van Schaik, Kak K. Yeung, Hence J. Verhagen, J. L. de Bruin, Marc R.H.M. van Sambeek, Ron Balm, Clark J Zeebregts, Joost A. van Herwaarden, J. D. Blankensteijn, DREAM trial participants

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1379-1389
Number of pages11
JournalJournal of Vascular Surgery
Volume66
Issue number5
DOIs
Publication statusPublished - 1 Nov 2017

Cite this

van Schaik, Theodorus G. ; Yeung, Kak K. ; Verhagen, Hence J. ; de Bruin, J. L. ; van Sambeek, Marc R.H.M. ; Balm, Ron ; Zeebregts, Clark J ; van Herwaarden, Joost A. ; Blankensteijn, J. D. ; DREAM trial participants. / Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. In: Journal of Vascular Surgery. 2017 ; Vol. 66, No. 5. pp. 1379-1389.
@article{64da3918803b44d890e59ce77f3a0880,
title = "Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms",
abstract = "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.",
author = "{van Schaik}, {Theodorus G.} and Yeung, {Kak K.} and Verhagen, {Hence J.} and {de Bruin}, {J. L.} and {van Sambeek}, {Marc R.H.M.} and Ron Balm and Zeebregts, {Clark J} and {van Herwaarden}, {Joost A.} and Blankensteijn, {J. D.} and {DREAM trial participants}",
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van Schaik, TG, Yeung, KK, Verhagen, HJ, de Bruin, JL, van Sambeek, MRHM, Balm, R, Zeebregts, CJ, van Herwaarden, JA, Blankensteijn, JD & DREAM trial participants 2017, 'Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms' Journal of Vascular Surgery, vol. 66, no. 5, pp. 1379-1389. https://doi.org/10.1016/j.jvs.2017.05.122

Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. / van Schaik, Theodorus G.; Yeung, Kak K.; Verhagen, Hence J.; de Bruin, J. L.; van Sambeek, Marc R.H.M.; Balm, Ron; Zeebregts, Clark J; van Herwaarden, Joost A.; Blankensteijn, J. D.; DREAM trial participants.

In: Journal of Vascular Surgery, Vol. 66, No. 5, 01.11.2017, p. 1379-1389.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms

AU - van Schaik, Theodorus G.

AU - Yeung, Kak K.

AU - Verhagen, Hence J.

AU - de Bruin, J. L.

AU - van Sambeek, Marc R.H.M.

AU - Balm, Ron

AU - Zeebregts, Clark J

AU - van Herwaarden, Joost A.

AU - Blankensteijn, J. D.

AU - DREAM trial participants

PY - 2017/11/1

Y1 - 2017/11/1

N2 - 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.

AB - 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.

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U2 - 10.1016/j.jvs.2017.05.122

DO - 10.1016/j.jvs.2017.05.122

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SP - 1379

EP - 1389

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

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