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The EVAR Trial 1: has it led to a change in practice?

C N Brown1, S Sangal, S Stevens

  • 1Department of Vascular and Endovascular Surgery, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK.

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
|August 5, 2010
PubMed

Insights

The publication of EVAR Trial 1 data did not immediately alter endovascular aneurysm repair (EVAR) rates. However, a long-term trend shows increased EVAR procedures, now surpassing open repairs (OR).

Area of Science:

  • Vascular Surgery
  • Clinical Practice Impact
  • Health Services Research

Background:

  • The EVAR Trial 1 results, published in June 2005, provided crucial data on endovascular aneurysm repair (EVAR) versus open repair (OR) for abdominal aortic aneurysms (AAAs).
  • Assessing the immediate and long-term impact of landmark trial publications on clinical practice is essential for understanding healthcare evolution.

Purpose of the Study:

  • To evaluate the effect of the EVAR Trial 1 publication on the adoption of EVAR in a specific clinical setting.
  • To compare practice patterns before and after the EVAR Trial 1 publication, and over a longer period.

Main Methods:

  • A retrospective analysis of all abdominal aortic aneurysm (AAA) repairs performed at a single center.
  • Comparison of data from the year preceding and the year following the EVAR Trial 1 publication (July 2004 - June 2006).
  • Extended comparison with data from the preceding six years (January 2000 - December 2006).

Main Results:

  • The proportion of EVARs performed did not significantly change in the year immediately following the EVAR Trial 1 publication (52% vs. 57%, p=0.64).
  • A significant decrease in the mean age of patients undergoing open repair (OR) was observed post-publication (69 vs. 72 years, p<0.05), without a change in their physiological fitness.
  • An overall increase in EVAR utilization was noted from 28% in 2000 to 57% in 2006.

Conclusions:

  • The EVAR Trial 1 publication did not cause an immediate shift in the percentage of EVARs performed at the center.
  • Over a six-year period, there has been a consistent rise in EVAR procedures, leading to EVAR becoming the predominant method of AAA repair in this unit.
Abstract

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