Invited commentary

Abstract

Several multicenter randomized trials have compared endovascular and open repair options in good-risk aneurysm patients, including the Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR-1) and Dutch Randomised Endovascular Aneurysm Management (DREAM) European studies that reported an early survival advantage after endovascular repair. The Veterans Affairs Study in the United States (OVER) completed recruitment of 881 patients in April 2007 and results are expected soon. The Anévrisme de l'aorte abdominale: Chirurgie versus Endoprothèse (ACE) study from France uses a similar study protocol and has completed recruitment of 306 patients. This report describes the challenges the French investigators have faced with regulatory bodies and funding agencies resulting in patient recruitment lagging 5 years after initial ethics approval. This environment may have contributed to the emergence of laparoscopic aortic surgery as a minimally invasive therapeutic option, which French surgeons have been pivotal in developing. The ACE investigators should be commended for their perseverance in completing this study. One wonders, though, with 306 patients recruited whether we will see a repeat of the early DREAM results (345 patients), where the early survival advantage was similar to that achieved with EVAR-1 and was viewed as clinically significant, but failed to reach statistical significance. Regardless, we await the results, which should be interesting and valuable. The ACE trial: A randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysmJournal of Vascular SurgeryVol. 50Issue 1PreviewEndovascular repair of infrarenal abdominal aneurysms (EVAR) is currently used in patients with large aneurysm. Two randomized studies, Dutch Randomised Endovascular Aneurysm Management (DREAM) and Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm (EVAR-1), showed favorable early results with EVAR; but at 2 and 4 years, the rates of all-cause mortalities were no longer different. Patients in EVAR groups required more reinterventions. These data were confirmed by national audits and large registries. Full-Text PDF Open Archive