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Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial

Lookup NU author(s): Dr Ruth Bell, Lyn Thompson, Natalie Wilson, Marie Dennis, Dr Michelle Davis, Dr Colin Nice, Dr Alison Howard, Jill Brown, Ann Gibson

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Abstract

Objective: To assess whether a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair reduces early mortality for patients with suspected ruptured abdominal aortic aneurysm. Design: Randomised controlled trial. Setting: 30 vascular centres (29 UK, 1 Canadian), 2009-13. Participants: 613 eligible patients (480 men) with a clinical diagnosis of ruptured aneurysm. Interventions: 316 patients were randomised to the endovascular strategy (275 confirmed ruptures, 174 anatomically suitable for endovascular repair) and 297 to open repair (261 confirmed ruptures). Main outcome measures: 30 day mortality, with 24 hour and in-hospital mortality, costs, and time and place of discharge as secondary outcomes. Results: 30 day mortality was 35.4% (112/316) in the endovascular strategy group and 37.4% (111/297) in the open repair group: odds ratio 0.92 (95% confidence interval 0.66 to 1.28; P=0.62); odds ratio after adjustment for age, sex, and Hardman index 0.94 (0.67 to 1.33). Women may benefit more than men (interaction test P=0.02) from the endovascular strategy: odds ratio 0.44 (0.22 to 0.91) versus 1.18 (0.80 to 1.75). 30 day mortality for patients with confirmed rupture was 36.4% (100/275) in the endovascular strategy group and 40.6% (106/261) in the open repair group (P=0.31). More patients in the endovascular strategy than in the open repair group were discharged directly to home (189/201 (94%) v 141/183 (77%); P<0.001). Average 30 day costs were similar between the randomised groups, with an incremental cost saving for the endovascular strategy versus open repair of £1186 (€ 1420; $1939) (95% confidence interval -£625 to £2997). Conclusions: A strategy of endovascular repair was not associated with significant reduction in either 30 day mortality or cost. Longer term cost effectiveness evaluations are needed to assess the full effects of the endovascular strategy in both men and women.


Publication metadata

Author(s): Powell JT, Sweeting MJ, Thompson MM, Ashleigh R, Bell R, Gomes M, Greenhalgh RM, Grieve R, Heatley F, Hinchliffe RJ, Thompson SG, Ulug P, Braithwaite B, Cheshire NJ, Grieve RJ, Hassan TB, Howell S, Moore F, Nicholson AA, Soong CV, Anjum A, Roberts I, Bell PRF, Cheetham A, Stephany J, Halliday A, Warlow C, Lamont P, Moss J, Tijssen J, Thompson L, Boyle JR, Serracino-Inglott F, Smyth JV, Wilson N, Bown M, Dennis M, Davis M, Wyatt MG, Valenti D, Bachoo P, Walker P, MacSweeney S, Davies JN, Rittoo D, Parvin SD, Yusuf W, Nice C, Chetter I, Howard A, Chong P, Bhat R, McLain D, Gordon A, Lane I, Hobbs S, Pillay W, Rowlands T, El-Tahir A, Asquith J, Cavanagh S, Forbes TL, Awopetu A, Baker S, Bourke P, Brady C, Brown J, Bryce J, Bufton C, Chance T, Chrisopoulou A, Cockell M, Croucher A, Curran G, Dabee L, Dewhirst N, Evans J, Gibson A, Gorst S, Gough M, Graves L, Griffin M, Hatfield J, Hogg F, Howard S, Hughes T, James A, Metcalfe D, Lapworth M, Massey I, Mohalhal A, Novick T, Owen G, Parr N, Pintar D, Smith T, Spencer S, Thomson C, Thunder O, Wallace T, Ward S, Wealleans V, Wilson L, Woods J, Zachariah M, Zheng T

Publication type: Article

Publication status: Published

Journal: BMJ

Year: 2014

Volume: 348

Online publication date: 13/01/2014

Acceptance date: 17/12/2013

Date deposited: 02/02/2018

ISSN (electronic): 1756-1833

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/bmj.f7661

DOI: 10.1136/bmj.f7661

PubMed id: 24418950


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