Blankensteijn shocks New York with DREAM results

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At the VEITHsymposium, in November 2008, Professor Jan Blankensteijn, Nijmegen, The Netherlands, gave four-year results of the Dutch Randomised Endovascular Aneurysm Management (DREAM) trial, but from the date of discharge.

His presentation suggested a higher mortality after EVAR as compared to open repair. At once, Dr Louise Brown, London, UK, noted the 3% perioperative benefit of the EVAR group that is excluded. Blankensteijn came back with the belief that the results are nevertheless likely to be real. This is because he has visualised a 10% to 15% benefit for open repair at four years from discharge and this is likely to swamp the benefit from perioperative period known to occur in the EVAR group. He stressed that intention to treat analysis at four years has not yet been performed and at best this is a possible trend. Blankensteijn delivered the news in such a way that the audience had to believe that he at least is ready to believe that open repair could win in the long term in DREAM.

 

Professor Roger Greenhalgh, London, UK, for the EVAR trialists, reported no such trends in the EVAR data out to four years and there have been no similar suspicions arising from ACE or OVER trials. He was pleased that the lead applicants have agreed in principle to put all four trials together as individual patient data for analysis in 2011 when trials have reported separately. Both Blankensteijn and Greenhalgh agreed that the real result will then be confirmed in this larger cohort. Both accepted that Blankensteijn has a suspicion but that “time will tell.” “My preparation was not intended to torpedo EVAR, but to indicate that the question which treatment is better has not been settled yet,” Blankensteijn told Vascular News.

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