Is a randomized trial necessary to determine whether endovascular repair is the preferred management strategy in patients with ruptured abdominal aortic aneurysms?

Mortality rates following repair of ruptured abdominal aortic aneurysms have remained depressingly high over the last number of decades despite advances in anesthesia and perioperative care. Prior to the introduction of endovascular repair, refinements in surgical technique had been few and far betw...

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Bibliographic Details
Published in:Journal of vascular surgery 2010-10, Vol.52 (4), p.1087-1093
Main Authors: Veith, Frank J., MD, Powell, Janet T., PhD, MD, FRCPath, Hinchliffe, Robert J., MD, FRCS
Format: Article
Language:English
Subjects:
Aortic Aneurysm, Abdominal - mortality
Aortic Aneurysm, Abdominal - surgery
Aortic Rupture - mortality
Aortic Rupture - surgery
Biological and medical sciences
Blood and lymphatic vessels
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - methods
Blood Vessel Prosthesis Implantation - mortality
Cardiology. Vascular system
Diseases of the aorta
Evidence-Based Medicine
Humans
Medical sciences
Patient Selection
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Mortality rates following repair of ruptured abdominal aortic aneurysms have remained depressingly high over the last number of decades despite advances in anesthesia and perioperative care. Prior to the introduction of endovascular repair, refinements in surgical technique had been few and far between. It was not until fairly recently that we finally observed a reduction in mortality coinciding with the wider adoption of endovascular repair. So, the case is closed, right? Endovascular repair should be widely adopted in all suitable patients? Well, not exactly. The following debate centers around what level of evidence is required to answer this question. Frank Veith argues that we're already there. He was an early adopter and innovator of endovascular techniques and feels that we have enough information to widely adopt endovascular repair of ruptured aneurysms. Janet Powell and Robert Hinchliffe, innovators in their own right, feel that the generalizability and applicability of endovascular repair require further evaluation with a randomized trial. Both offer clear and reasoned arguments.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2010.05.142