Immediate Open Repair vs Surveillance in Patients with Small Abdominal Aortic Aneurysms: Survival Differences by Aneurysm Size |
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Authors: | Giovanni Filardo Frank A Lederle David J Ballard Cody Hamilton Briget da Graca Jeph Herrin Jessica Harbor Julie B VanBuskirk Gary R Johnson Janet T Powell |
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Institution: | 1. Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX;2. Baylor University Medical Center, Dallas, TX;3. Department of Infectious Diseases, University of Louisville, Louisville, KY;4. The Heart Hospital at Baylor Plano, Plano, TX;5. Department of Medicine, Veterans Affairs Medical Center, Minneapolis, MN;6. Department of Biostatistics, Heart Valve Therapies, Edwards Lifesciences, Irvine, CA;7. Department of Cardiology, Yale University School of Medicine, New Haven, CT;8. Health Research and Educational Trust, Chicago, IL;9. VA Cooperative Studies Program Coordinating Center, West Haven, CT;10. Vascular Surgery, Imperial College at Charing Cross, London, UK |
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Abstract: | ObjectiveTo assess whether survival differences exist between patients undergoing immediate open repair vs surveillance with selective repair for 4.0- to 5.4-cm abdominal aortic aneurysms (AAAs) and whether these differences vary by diameter, within sexes, or overall.Patients and MethodsThe study cohort included 2226 patients randomized to immediate repair or surveillance for the UK Small Aneurysm Trial (September 1, 1991, through July 31, 1998; follow-up, 2.6-6.9 years) or the Aneurysm Detection and Management trial (August 1, 1992, through July 31, 2000; follow-up, 3.5-8.0 years). Survival differences were assessed with proportional hazard models, adjusted for a comprehensive array of clinical and nonclinical risk factors. Interaction between treatment and AAA size was added to the model to assess whether the effect of immediate open repair vs surveillance varied by AAA size.ResultsThe adjusted analysis revealed no statistically significant survival difference between immediate open repair and surveillance patients (hazard ratio HR], 0.99; 95% CI, 0.83-1.18; mean follow-up time, 1921 days for both study groups). This lack of treatment effect persisted when men (HR, 1.01; 95% CI, 0.84-1.21) and women (HR, 0.96; 95% CI, 0.49-1.86) were examined separately and did not vary by AAA size (P=.39 for the entire cohort and P=.24 for women).ConclusionImmediate open repair offered no significant survival benefit, even in patients with the largest AAAs and highest risk of rupture. Because recent trials failed to find a survival benefit of immediate endovascular repair over surveillance for small asymptomatic AAAs, our findings suggest that the gray area of first-line management for these patients should be resolved in favor of surveillance. |
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Keywords: | AAA"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"abdominal aortic aneurysm ADAM"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"Aneurysm Detection and Management CAESAR"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"Comparison of Surveillance versus Aortic Endografting for Small Aneurysm Repair EVAR"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"endovascular aneurysm repair HR"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"hazard ratio PIVOTAL"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"Positive Impact of Endovascular Options for Treating Aneurysms Early UKSAT"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"United Kingdom Small Aneurysm Trial |
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