EVAR trial participants (2005) Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 365: 2187–2192

The endovascular aneurysm repair (EVAR) technique was developed to help manage patients with large abdominal aortic aneurysms who were considered unfit for open repair surgery. The EVAR trial 2 assessed patient outcomes following EVAR surgery in terms of all-cause mortality, aneurysm-related mortality, health-related quality of life, postoperative complications and hospital costs.

Patients aged 60 years or older with an aneurysm of at least 5.5 cm in diameter were referred from any of 31 UK hospitals, with 166 patients randomized to undergo EVAR and 172 patients to receive no surgical intervention.

In the EVAR group, the actual 30-day operative mortality was 7%, while the intention-to-treat mortality was 9% because of aneurysm ruptures before surgery. Over 4 years, there were no statistically significant differences in all-cause mortality or aneurysm-related mortality between the EVAR and no-intervention groups. Reintervention was necessary in 26% of patients in the EVAR group compared with 4% in the no-intervention group. Mean hospital costs were also higher for patients who underwent EVAR surgery compared to those who did not. No differences in health-related quality-of-life scores were reported between the two groups.

In conclusion, EVAR does not improve survival in patients deemed unfit for open repair surgery, and is associated with an increased risk of postoperative complications and high hospital costs.