• Jan D Blankensteijn, Sjors E C A de Jong, Monique Prinssen, Arie C van der Ham, Jaap Buth, Steven M M van Sterkenburg, Hence J M Verhagen, Erik Buskens, Diederick E Grobbee, and Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group.
• Department of Vascular Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. j.blankensteijn@chir.umcn.nl
• N. Engl. J. Med. 2005 Jun 9; 352 (23): 239824052398-405.

BackgroundTwo randomized trials have shown better outcomes with elective endovascular repair of abdominal aortic aneurysms than with conventional open repair in the first month after the procedure. We investigated whether this advantage is sustained beyond the perioperative period.MethodsWe conducted a multicenter, randomized trial comparing open repair with endovascular repair in 351 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. Survival after randomization was calculated with the use of Kaplan-Meier analysis and compared with the use of the log-rank test on an intention-to-treat-basis.ResultsTwo years after randomization, the cumulative survival rates were 89.6 percent for open repair and 89.7 percent for endovascular repair (difference, -0.1 percentage point; 95 percent confidence interval, -6.8 to 6.7 percentage points). The cumulative rates of aneurysm-related death were 5.7 percent for open repair and 2.1 percent for endovascular repair (difference, 3.7 percentage points; 95 percent confidence interval, -0.5 to 7.9 percentage points). This advantage of endovascular repair over open repair was entirely accounted for by events occurring in the perioperative period, with no significant difference in subsequent aneurysm-related mortality. The rate of survival free of moderate or severe complications was also similar in the two groups at two years (at 65.9 percent for open repair and 65.6 percent for endovascular repair; difference, 0.3 percentage point; 95 percent confidence interval, -10.0 to 10.6 percentage points).ConclusionsThe perioperative survival advantage with endovascular repair as compared with open repair is not sustained after the first postoperative year.Copyright 2005 Massachusetts Medical Society.

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