A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm

Abstract

Objective: The purpose of this study was to evaluate the safety and efficacy of a novel endovascular graft for elective treatment of infrarenal abdominal aortic aneurysm. The device is a modular bifurcated system with nitinol/expanded polytetrafluoroethylene components and a smaller profile than currently approved devices. Methods: In a multicenter, concurrent controlled phase II trial, 334 patients underwent treatment with the Excluder bifurcated endoprosthesis (test, n = 235; W. L. Gore & Associates, Inc, Sunnyvale, Calif) or with standard open repair (control, n = 99). Preoperative characteristics, perioperative variables, follow-up clinicalevaluations, and radiographic examination results through the first 2 years were analyzed with univariable and multivariable statistics. Results: Patients in the test group had less blood loss (310 ± 19 mL versus 1590 ± 124 mL; P < .0001), fewer homologous transfusions (6% versus 32%; P < .0001), and shorter lengths of stay (2.0 ± 0.1 days versus 9.8 ± 1.4 days; P < .0001). Early major adverse events were markedly reduced in the test group (14% versus 57%; P < .0001), and this difference persisted at 2 years. No difference was seen in survival rate (P = .13). In the first 2 years, no deployment failure, early conversion, or aneurysm rupture occurred. At the 2-year timepoint, core laboratory read trunk migration in 1%, limb migration in 1%, limb narrowing in 1%, endoleak in 20%, and aneurysm growth in 14%. One wire discontinuity (0.6%) was identified in a discharge film. A 7% annual reintervention rate was seen in the test group in the first 2 years. Summary: The test device is a safe and effective treatment compared with open surgical repair for infrarenal abdominal aortic aneurysm. The most striking benefits are reduced blood loss, fewer complications, and faster recovery. Two-year survival rate was similar.