What are the results of the major EVAR studies?
The EVAR 1 trial showed a 3% lower initial mortality for EVAR, with a persistent reduction in aneurysm-related death at 4 years. Improvement in overall late survival was not shown. Similarly, the DREAM trial observed an initial mortality advantage for EVAR, but overall 1-year survival was equivalent in both groups. The EVAR 2 trial did not show a survival advantage of EVAR with respect to nonoperative management, although the design of this trial has been heavily debated. The Medicare matched cohort study concluded that, compared with open repair, endovascular repair of AAA is associated with lower short-term rates of death and complications. The survival advantage was more durable among older patients. In the Lifeline Registry, patients receiving endovascular grafts were older and had more cardiac comorbidities compared with surgical controls (e.g., open repair), but there was no difference in the primary end points of all-cause mortality, AAA death, or aneurysm rupture between the endovascular graft and surgical control groups up to 3 years.