EVAR II IS Misleading: Patients Unfit For Open Repair Can Undergo EVAR With Improved Survival And Quality Of Life At An Acceptable Cost

Main Category: Cardiovascular / Cardiology
Article Date: 24 Nov 2008 - 6:00 PDT

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EVAR trials have engendered cynicism, trepidation and scepticism concerning the optimal contemporary management and natural history of high risk patients for OR.

Sherif Sultan of the Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital, in Galway, Ireland, has stated that patients unfit for open repair can indeed undergo EVAR with improvement in survival rates and overall quality of life - and at an acceptable cost.

The aim of Dr. Sultan's study has been to scrutinize EVAR as a feasible opportunity for high-risk patients and evaluate whether it can enhance survival and foster Quality Time spent Without Symptoms of disease or Toxicity of treatment (QTWiST) in a cost effective manner.

As of 2002-2007, 1083 patients with aortic disease were referred to Dr. Sultan's center, of which 162 were high-risk elective patients with AAA and anatomically suitable for EVAR.

Patients were opted for OR (n=52), EVAR (n=66) or BMT (n=44) following comprehensive consultation with the patient, their family and primary physician. Four years aneurysmrelated survival following EVAR (96.7%) was markedly improved compared to best medical therapy (BMT) (66.8%) and similar to OR (93.9%). Thirty day morbidity was significantly improved for EVAR (6%) compared to OR (23%). At four years follow-up, the assessment of quality of life using Q-TWiST was 3.64 years for EVAR, 3.6 years for OR and 2.22 years for BMT.

Sensitivity Analysis showed that Q-TWIST was significantly improved with EVAR compared to OR over a full range of utility values between 0 and 1 (P<0.0032).

Dr. Sultan stated, "We believe that in high-risk patients, EVAR reduced aneurysm-related death compared to best medical treatment. Equated to the gold-standard of OR, EVAR, as a 'one time procedure', substantially reduces operative morbidity, hospital stay, costs and utilization of intensive care facilities if the patient is managed in a high deliberate practice volume centre. However, we must identify a subgroup of patients who are "too high risk" for any intervention."

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Source
Pauline T. Mayer
www.ptmhcm.com