Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan 23;2014(1):CD004178.
doi: 10.1002/14651858.CD004178.pub2.

Endovascular repair of abdominal aortic aneurysm

Sharath Chandra Vikram Paravastu  1 , Rubaraj Jayarajasingam, Rachel Cottam, Simon J Palfreyman, Jonathan A Michaels, Steven M Thomas
Affiliations

Endovascular repair of abdominal aortic aneurysm

Sharath Chandra Vikram Paravastu et al. Cochrane Database Syst Rev. .

Abstract

Background: An abnormal dilatation of the abdominal aorta is referred to as an abdominal aortic aneurysm (AAA). Due to the risk of rupture, surgical repair is offered electively to individuals with aneurysms greater than 5.5 cm in size. Traditionally, conventional open surgical repair (OSR) was considered the first choice approach. However, over the past two decades endovascular aneurysm repair (EVAR) has gained popularity as a treatment option. This article intends to review the role of EVAR in the management of elective AAA.

Objectives: To assess the effectiveness of EVAR versus conventional OSR in individuals with AAA considered fit for surgery, and EVAR versus best medical care in those considered unfit for surgery. This was determined by the effect on short, intermediate and long-term mortality, endograft related complications, re-intervention rates and major complications.

Search methods: The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (January 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12). The TSC also searched trial databases for details of ongoing or unpublished studies.

Selection criteria: Prospective randomised controlled trials (RCTs) comparing EVAR with OSR in individuals with AAA considered fit for surgery. and comparing EVAR with best medical care in individuals considered unfit for surgery. We excluded studies with inadequate data or using an inadequate randomisation technique.

Data collection and analysis: Three reviewers independently evaluated trials for appropriateness for inclusion and extracted data using pro forma designed by the Cochrane PVD Group. We assessed the quality of trials using The Cochrane Collaboration's 'Risk of bias' tool. We entered collected data in to Review Manager (version 5.2.3) for analysis. Where direct comparisons could be made, we determined odds ratios (OR). We tested studies for heterogeneity and, when present, we used a random-effects model; otherwise we used a fixed-effect model. We tabulated data that could not be collated.

Main results: Four high-quality trials comparing EVAR with OSR (n = 2790) and one high-quality trial comparing EVAR with no intervention (n = 404) fulfilled the inclusion criteria. In individuals considered fit for surgery, a pooled analysis, including 1362 individuals randomised to EVAR and 1361 randomised to OSR, found short-term mortality (including 30-day or inhospital mortality, excluding deaths prior to intervention) with EVAR to be significantly lower than with OSR (1.4% versus 4.2%, OR 0.33, 95% confidence interval (CI) 0.20 to 0.55; P < 0.0001). Using intention-to-treat analysis (ITT) there was no significant difference in mortality at intermediate follow-up (up to four years from randomisation), with 221 (15.8%) and 237 (17%) deaths in the EVAR (n = 1393) and OSR (n = 1390) groups, respectively (OR 0.92, 95% CI 0.75 to 1.12; P = 0.40). There was also no significant difference in long-term mortality (beyond four years), with 464 (37.3%) deaths in the EVAR and 470 (37.8%) deaths in the OSR group (OR 0.98, 95% CI 0.83 to 1.15; P = 0.78). Similarly, there was no significant difference in aneurysm-related mortality between groups, either at the intermediate- or long-term follow up.Studies showed that both EVAR and OSR were associated with similar incidences of cardiac deaths (OR 1.14, 95% CI 0.86 to 1.52; P = 0.36) and fatal stroke rate (OR 0.81, 95% CI 0.42 to 1.55; P = 0.52). The long-term reintervention rate was significantly higher in the EVAR group than in the OSR group (OR 1.98, 95% CI 1.12 to 3.51; P = 0.02; I(2) = 85%). Results of the reintervention analysis should be interpreted with caution due to significant heterogeneity. Operative complications, health-related quality of life and sexual dysfunction were generally comparable between the EVAR and OSR groups. However, there was a slightly higher incidence of pulmonary complications in the OSR group compared with the EVAR group (OR 0.36, 95% CI 0.17 to 0.75; P = 0.006).In individuals considered unfit for conventional OSR, the one included trial found no difference between the EVAR and no-intervention groups with regard to all-cause mortality at final follow up, with 21.0 deaths per 100 person-years in the EVAR group and 22.1 deaths per 100 person years in the no-intervention group (adjusted hazard ratio (HR) with EVAR 0.99, 95% CI 0.78 to 1.27; P = 0.97). Aneurysm-related deaths were, however, significantly higher in the no-intervention group than in the EVAR group (adjusted HR 0.53, 95% CI 0.32 to 0.89; P = 0.02). There was no difference in myocardial events (HR 1.07, 95% CI 0.60 to 1.91) between the groups in this study.

Authors' conclusions: In individuals considered fit for conventional surgery, EVAR was associated with lower short-term mortality than OSR. However, this benefit from EVAR did not persist at the intermediate- and long-term follow ups. Individuals undergoing EVAR had a higher reintervention rate than those undergoing OSR. Most of the reinterventions undertaken following EVAR, however, were catheter-based interventions associated with low mortality. Operative complications, health-related quality of life and sexual dysfunction were generally comparable between EVAR and OSR. However, there was a slightly higher incidence of pulmonary complications in the OSR group than in the EVAR group.In individuals considered unfit for open surgery, the results of a single trial found no overall short- or long-term benefits of EVAR over no intervention with regard to all-cause mortality, but individuals may differ and individual preferences should always be taken into account.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 EVAR versus OSR in the management of fit individuals: all‐cause mortality, Outcome 1 Short term mortality (30‐day or in‐hospital) (excluding participants who died before surgery and those who did not undergo any intervention).
1.2
1.2. Analysis
Comparison 1 EVAR versus OSR in the management of fit individuals: all‐cause mortality, Outcome 2 Intermediate mortality (up to 4 years, ITT analysis).
1.3
1.3. Analysis
Comparison 1 EVAR versus OSR in the management of fit individuals: all‐cause mortality, Outcome 3 Long term mortality (beyond 4 years, ITT analysis).
2.1
2.1. Analysis
Comparison 2 EVAR versus OSR in the management of fit individuals: AAA‐related mortality, Outcome 1 Intermediate AAA‐related mortality (up to four years).
2.2
2.2. Analysis
Comparison 2 EVAR versus OSR in the management of fit individuals: AAA‐related mortality, Outcome 2 Long term AAA‐related mortality (beyond 4 years).
3.1
3.1. Analysis
Comparison 3 EVAR versus OSR in the management of fit individuals: reintervention, Outcome 1 Intermediate reintervention (up to four years).
3.2
3.2. Analysis
Comparison 3 EVAR versus OSR in the management of fit individuals: reintervention, Outcome 2 Long term reintervention (beyond 4 years).
5.1
5.1. Analysis
Comparison 5 EVAR versus OSR in the management of fit individuals: myocardial complications, Outcome 1 Cardiac related deaths.
6.1
6.1. Analysis
Comparison 6 EVAR versus OSR in the management of fit individuals: stroke, Outcome 1 Non‐fatal stroke.
6.2
6.2. Analysis
Comparison 6 EVAR versus OSR in the management of fit individuals: stroke, Outcome 2 Fatal stroke.
7.1
7.1. Analysis
Comparison 7 EVAR versus OSR in the management of fit individuals: pulmonary complications, Outcome 1 Pulmonary complications.
7.2
7.2. Analysis
Comparison 7 EVAR versus OSR in the management of fit individuals: pulmonary complications, Outcome 2 Pulmonary related deaths.
8.1
8.1. Analysis
Comparison 8 EVAR versus OSR in the management of fit individuals: renal complications, Outcome 1 Renal complications.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

ACE {published data only}
    1. Becquemin JP. The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm. Journal of Vascular Surgery 2009;50(1):222‐4. - PubMed
    1. Becquemin JP, Pillet JC, Lescalie F, Sapoval M, Goueffic Y, Lermusiaux P, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low‐ to moderate‐risk patients. Journal of Vascular Surgery 2011;53(5):1167‐73. - PubMed
DREAM {published data only}
    1. Baas AF, Janssen KJ, Prinssen M, Buskens E, Blankensteijn JD. The Glasgow Aneurysm Score as a tool to predict 30‐day and 2‐year mortality in the patients from the Dutch Randomized Endovascular Aneurysm Management trial. Journal of Vascular Surgery 2008;47(2):277‐81. - PubMed
    1. Blankensteijn JD, Jong SE, Prinssen M, Ham AC, Buth J, Sterkenburg SM, et al. Two‐year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. New England Journal of Medicine 2005;352(23):2398‐405. - PubMed
    1. Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, et al. Long‐term outcome of open or endovascular repair of abdominal aortic aneurysm. New England Journal of Medicine 2010;362(20):1881‐9. - PubMed
    1. Prinssen M, Buskens E, Blankensteijn J, DREAM‐Trial participants. Quality of life after endovascular and open AAA repair. Results of a randomised trial. European Society for Vascular Surgery, Programme and Abstract Book, XVII Annual Meeting and Course on Vascular Surgical Techniques. 2003:66‐7. - PubMed
    1. Prinssen M, Buskens E, Blankensteijn JD. The Dutch Randomised Endovascular Aneurysm Management (DREAM) trial. Background, design and methods. Journal of Cardiovascular Surgery 2002;43(3):379‐84. - PubMed
EVAR1 {published data only}
    1. Brown L, Greenhalgh R, Powell J, Thompson S, on behalf of the EVAR Trial Participants. Cardiovascular events and the convergence of mid‐term mortality after endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm. The Vascular Society of Great Britain & Ireland Yearbook 44th Annual Meeting; 18‐20 November 2009, Liverpool, UK. 2009:63.
    1. Brown LC, Brown EA, Greenhalgh RM, Powell JT, Thompson SG, UK EVAR Trial Participants. Renal function and abdominal aortic aneurysm (AAA): the impact of different management strategies on long‐term renal function in the UK EndoVascular Aneurysm Repair (EVAR) trials. Annals of Surgery 2010;251(5):966‐75. - PubMed
    1. Brown LC, Epstein D, Manca A, Beard JD, Powell JT, Greenhalgh RM. The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress. European Journal of Vascular and Endovascular Surgery 2004;27(4):372‐81. - PubMed
    1. Brown LC, Greenhalgh RM, Howell S, Powell JT, Thompson SG. Patient fitness and survival after abdominal aortic aneurysm repair in patients from the UK EVAR trials. British Journal of Surgery 2007;94(6):709‐16. - PubMed
    1. Brown LC, Greenhalgh RM, Kwong GP, Powell JT, Thompson SG, Wyatt MG. Secondary interventions and mortality following endovascular aortic aneurysm repair: device‐specific results from the UK EVAR Trials. European Journal of Vascular and Endovascular Surgery 2007;34(3):281‐90. - PubMed
EVAR2 {published data only}
    1. Brown LC, Epstein D, Manca A, Beard JD, Powell JT, Greenhalgh RM. The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress. European Journal of Vascular and Endovascular Surgery 2004;27(4):372‐81. - PubMed
    1. Brown LC, Greenhalgh RM, Howell S, Powell JT, Thompson SG. Patient fitness and survival after abdominal aortic aneurysm repair in patients from the UK EVAR trials. British Journal of Surgery 2007;94(6):709‐16. - PubMed
    1. Brown LC, Greenhalgh RM, Thompson SG, Powell JT, EVAR Trial Participants. Does EVAR alter the rate of cardiovascular events in patients with abdominal aortic aneurysm considered unfit for open repair? Results from the randomised EVAR trial 2. European Journal of Vascular and Endovascular Surgery 2010;39(4):396‐402. - PubMed
    1. EVAR 2 Trial Participants. Does aneurysm rupture risk decrease in patients who are anatomically suitable for endovascular repair?. The Vascular Society of Great Britain & Ireland 42nd Annual Meeting; 28‐30 November 2007; Manchester, UK. 2007:89.
    1. EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005;365(9478):2187‐92. - PubMed
OVER {published data only}
    1. Kyriakides TC, Lederle F, Freischlag J. Open versus endovascular repair of abdominal aortic aneurysms: the OVER trial. Clinical Trials 2004; Vol. 1, issue Suppl 1:212.
    1. Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT Jr, Kohler TR, et al. Long‐term comparison of endovascular and open repair of abdominal aortic aneurysm. New England Journal of Medicine 2012;367(21):1988‐97. - PubMed
    1. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009;302(14):1535‐42. - PubMed
    1. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FTJ, Matsumura JS Kohler TR. Two‐year comparison of endovascular and open repair of abdominal aortic aneurysms. Journal of Vascular Surgery 2009;50(2):447.
    1. Lederle FA, Stroupe KT, Open versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Cost‐effectiveness at two years in the VA Open versus Endovascular Repair trial. European Journal of Vascular and Endovascular Surgery 2012;44(6):543‐8. - PubMed

References to studies excluded from this review

CAESAR Trial {published data only}
    1. Cao P, CAESAR Trial Collaborators. Comparison of surveillance vs Aortic Endografting for Small Aneurysm Repair (CAESAR) trial: study design and progress. European Journal of Vascular and Endovascular Surgery 2005;30(3):245‐51. - PubMed
    1. Cao P, Rango P, Verzini F, Parlani G, Romano L, Cieri E. Comparison of Surveillance Versus Aortic Endografting for Small Aneurysm Repair (CAESAR): results from a randomised trial. European Journal of Vascular and Endovascular Surgery 2011;41(1):13‐25. - PubMed
    1. NCT00118573. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR). http://clinicaltrials.gov/ct/show/NCT00118573?order=1 (accessed 6 December 2013).
Cuypers 2001 {published data only}
    1. Cuypers PW, Gardien M, Buth J, Peels CH, Charbon JA, Hop WC. Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair. British Journal of Surgery 2001;88(8):1059‐65. - PubMed
ECAR study 2010 {published data only}
    1. Desgranges P, Kobeiter H, Castier Y, Senechal M, Majewski M, Krimi A. The Endovasculaire vs Chirurgie dans les Anevrysmes Rompus PROTOCOL trial update. Journal of Vascular Surgery 2010;51(1):267‐70. - PubMed
IMPROVE trial {unpublished data only}
    1. IMPROVE Trial, Powell JT, Thompson SG, Thompson MM, Grieve R, Nicholson AA, Ashleigh R, et al. The Immediate Management of the Patient with Rupture: Open Versus Endovascular repair (IMPROVE) aneurysm trial‐‐ISRCTN 48334791 IMPROVE trialists. Acta Chirurgica Belgica 2009;109(6):678‐80. - PubMed
Lottman 2004 {published data only}
    1. Lottman PE, Laheij RJ, Cuypers PW, Bender M, Buth J. Health‐related quality of life outcomes following elective open or endovascular AAA repair: a randomized controlled trial. Journal of Endovascular Therapy 2004;11(3):323‐9. - PubMed
PIVOTAL Trial {published data only}
    1. NCT00444821. The (PIVOTAL) study. http://clinicaltrials.gov/ct/show/NCT00444821?order=1 (accessed 6 December 2013).
    1. Ouriel K. The PIVOTAL study: A randomized comparison of endovascular repair versus surveillance in patients with smaller abdominal aortic aneurysms. Journal of Vascular Surgery 2009;49(1):266‐9. - PubMed
    1. Ouriel K, Clair DG, Kent KC, Zarins CK, PIVOTAL Investigators. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. Journal of Vascular Surgery 2009;50(2):449. - PubMed
Soulez 2005 {published data only}
    1. Soulez G, Thérasse E, Monfared AA, Blair JF, Choiniére M, Elkouri S, et al. Pain and quality of life assessment after endovascular versus open repair of abdominal aortic aneurysms in patients at low risk. Journal of Vascular Interventional Radiology 2005;16(8):1093‐100. - PubMed

References to ongoing studies

NExT ERA {unpublished data only}
    1. Mastracci TM, Clase CM, Devereaux PJ, Cinà CS. Open versus endovascular repair of abdominal aortic aneurysm: a survey of Canadian vascular surgeons. Canadian Journal of Surgery 2008;51(2):142‐8, quiz 149. - PMC - PubMed

Additional references

AAAQIP 2011
    1. The Abdominal Aortic Aneurysm Quality Improvement Programme Team. National abdominal aortic aneurysm quality improvement programme. Vascular Society of Great Britain and Ireland, http://www.vascularsociety.org.uk/vascular/wp‐content/uploads/2012/11/Na... (accessed 4 July 2013).
Armon 1998
    1. Armon MP, Hopkinson BR. How much does an aorto‐uni‐iliac stent‐graft increase the endovascular options for abdominal aortic aneurysm repair?. In: Greenhalgh RM editor(s). Indications in Vascular and Endovascular Surgery. London: Saunders, 1998:221‐7.
Bengtsson 1993
    1. Bengtsson H, Bergqvist D. Ruptured abdominal aortic aneurysm: a population‐based study. Journal of Vascular Surgery 1993;18(1):74‐80. - PubMed
Budd 1989
    1. Budd JS, Finch DR, Carter PG. A study of the mortality from ruptured abdominal aortic aneurysms in a district community. European Journal of Vascular Surgery 1989;3(4):351‐4. - PubMed
Campbell 1986
    1. Campbell WB, Collin J, Morris PJ. The mortality of abdominal aortic aneurysm. Annals of the Royal College of Surgeons of England 1986;68(5):275‐8. - PMC - PubMed
Dangas 2012
    1. Dangas G, O'Connor D, Firwana B, Brar S, Ellozy S, Vouyouka A, et al. Open versus endovascular stent graft repair of abdominal aortic aneurysms: a meta‐analysis of randomized trials. JACC: Cardiovascular Interventions 2012;5(10):1071‐80. - PubMed
Eskandari 1998
    1. Eskandari MK, Bowles SA, Webster MW, Steed DL, Makaroun MS, Muluk SC, et al. Ruptured abdominal aortic aneurysms in the 1990s: resource utilization, long‐term survival and quality of life after repair. Vascular and Endovascular Surgery 1998;32(5):415‐24.
EVAR1 2005
    1. EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005;365(9478):2179‐86. - PubMed
Feinglass 1995
    1. Feinglass J, Cowper D, Dunlop D, Slavensky R, Martin GJ, Pearce WH. Late survival risk factors for abdominal aortic aneurysm repair: experience from fourteen Department of Veterans Affairs hospitals. Surgery 1995;118(1):16‐24. - PubMed
Gadowski 1994
    1. Gadowski GR, Pilcher DB, Ricci MA. Abdominal aortic aneurysm expansion rate: effect of size and beta‐adrenergic blockade. Journal of Vascular Surgery 1994;19(4):727‐31. - PubMed
Giles 2011
    1. Giles KA, Landon BE, Cotterill P, O'Malley AJ, Pomposelli FB, Schermerhorn ML. Thirty‐day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries. Journal of Vascular Surgery 2011;53(1):6‐13. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG. Chapter 8: Assessing Risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. Available from www.cochrane‐handbook.org.
Holt 2009
    1. Holt PJ, Poloniecki JD, Khalid U, Hinchliffe RJ, Loftus IM, Thompson MM. Effect of endovascular aneurysm repair on the volume‐outcome relationship in aneurysm repair. Circulation. Cardiovascular quality and outcomes 2009;2(6):624‐32. - PubMed
Ingoldby 1986
    1. Ingoldby CJ, Wujanto R, Mitchell JE. Impact of vascular surgery on community mortality from ruptured aortic aneurysms. British Journal of Surgery 1986;73(7):551‐3. - PubMed
Johansson 1986
    1. Johansson G, Swedenborg J. Ruptured abdominal aortic aneurysms: a study of incidence and mortality. British Journal of Surgery 1986;73(2):101‐3. - PubMed
Kantonen 1999
    1. Kantonen I, Lepantalo M, Brommels M, Luther M, Salenius JP, Ylonen K. Mortality in ruptured abdominal aortic aneurysms. The Finnvasc Study Group. European Journal of Vascular and Endovascular Surgery 1999;17(3):208‐12. - PubMed
Karthikesalingam 2013
    1. Kathikesalingam A, Thompson MM. Repair of infrarenal aortic aneurysm ‐ the debate is OVER. Nature Review in Cardiology 2013;10(3):122‐4. - PubMed
Khoo 1994
    1. Khoo DE, Ashton H, Scott RA. Is screening once at age 65 an effective method for detection of abdominal aortic aneurysms?. Journal of Medical Screening 1994;1(4):223‐5. - PubMed
Leach 1988
    1. Leach SD, Toole AL, Stern H, DeNatale RW, Tilson MD. Effect of beta‐adrenergic blockade on the growth rate of abdominal aortic aneurysms. Archives of Surgery 1988;123(5):606‐9. - PubMed
Mutirangura 1989
    1. Mutirangura P, Stonebridge PA, Clason AE, McClure JH, Wildsmith JA, Nolan B, et al. Ten‐year review of non‐ruptured aortic aneurysms. British Journal of Surgery 1989;76(12):1251‐4. - PubMed
NICE EVAR 2012
    1. National Institute for Health and Clinical Excellence. Endovascular stent–grafts for the treatment of abdominal aortic aneurysms. http://www.nice.org.uk/ (accessed 4 July 2013).
Olsen 1991
    1. Olsen PS, Schroeder T, Agerskov K, Roder O, Sorensen S, Perko M, et al. Surgery for abdominal aortic aneurysms. A survey of 656 patients. Journal of Cardiovascular Surgery 1991;32(5):636‐42. - PubMed
Parodi 1991
    1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Annals of Vascular Surgery 1991;5(6):491‐9. - PubMed
Scott 1995
    1. Scott RA, Wilson NM, Ashton HA, Kay DN. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5‐year results of a randomized controlled study. British Journal of Surgery 1995;82(8):1066‐70. - PubMed
Steyerberg 1995
    1. Steyerberg EW, Kievit J, Mol Van Otterloo JC, Bockel JH, Eijkemans MJ, Habbema JD. Perioperative mortality of elective abdominal aortic aneurysm surgery. A clinical prediction rule based on literature and individual patient data. Archives of Internal Medicine 1995;155(18):1998‐2004. - PubMed
Takolander 1998
    1. Takolander R. Conservative treatment, stent grafting or open repair of abdominal aortic aneurysms. Annales Chirurgiae et Gynaecologiae 1998;87(2):167‐70. - PubMed
Thomas 1988
    1. Thomas PR, Stewart RD. Abdominal aortic aneurysm. British Journal of Surgery 1988;75(8):733‐6. - PubMed
Thomas 2002
    1. Thomas SM, Palfreyman SSJ, Michaels JA, Cleveland TJ, Gaines PA. Endovascular repair of abdominal aortic aneurysm. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD004178] - DOI - PMC - PubMed
Thomas 2005
    1. Thomas SM, Beard JD, Ireland M, Ayers S, Vascular Society of Great Britain and Ireland, British Society of Interventional Radiology. Results from the prospective registry of endovascular treatment of abdominal aortic aneurysms (RETA): mid term results to five years. European Journal of Vascular and Endovascular Surgery 2005;29(6):563‐70. - PubMed
UKSAT 1998
    1. The UK Small Aneurysm Trial Participants. Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 1998;352(9141):1649‐55. - PubMed
Walton 1999
    1. Walton LJ, Franklin IJ, Bayston T, Brown LC, Greenhalgh RM, Taylor GW, et al. Inhibition of prostaglandin E2 synthesis in abdominal aortic aneurysms: implications for smooth muscle cell viability, inflammatory processes, and the expansion of abdominal aortic aneurysms. Circulation 1999;100(1):48‐54. - PubMed
Zarins 1997
    1. Zarins CK, Harris EJ Jr. Operative repair for aortic aneurysms: the gold standard [review]. Journal of Endovascular Surgery 1997;4(3):232‐41. - PubMed

Publication types

MeSH terms

LinkOut - more resources