CX 31 angles on EVAR


The endovascular repair of abdominal aortic aneurysm (EVAR) vs. open repair debate will rage on at this year’s CX Symposium. Evidence from recent trials has started to build a credible picture of clinical effectiveness, but debate in the field has pitted improved short-term mortality rates and quicker recovery time with endovascular treatment against uncertain long-term prospects and a greater need for reintervention. At the CX Syposium, however, two alternative angles will be given expert attention.

Determining the cost-effectiveness of EVAR

In the present climate, economic arguments are taking centre stage, and even the field of vascular medicine is feeling the impact. David Epstein, Honorary Visiting Fellow at the University of York Centre for Health Economics, UK, will, on Sunday 5 April, present a decision model to evaluate the various studies assessing the cost-effectiveness of endovascular repair.

Recent studies, such as the EVAR and DREAM trials have provided evidence which can be used to make economic cases for or against endovascular aneurysm repair. Both trials produced some data to support use of EVAR repair in certain cases, with shorter hospital stays being an important factor in its favour. But higher acquisitions costs and scant long-term data mean that a decision is far from clear cut.

“The health service aims to ensure that patients are offered effective and cost-effective therapies that make the best use of limited resources,” Epstein told Vascular News. “The EVAR trial found that despite the initial benefits of EVAR, after only two years there was no difference in survival.

Age and EVAR

Also on the Sunday, a clash of Titans is promised when Kevin Burnand of King’s College London, UK, and Rob Morgan, St George’s Hospital, London, UK, go head-to-head to debate patient selection for endovascular and open repair.

Burnand will be supporting the motion that a fit 69 year old with an abdominal aortic aneurysm should have open repair. “I am looking forward to debating a clinical subject with a radiologist, a group of doctors not noted for their clinical skills!” Burnand said.

“Open surgery is tried and tested and has very few complications requiring limited follow-up,” he argues. “By one year there is no difference in the overall mortality of open and endovascular surgery (EVAR1 and DREAM trials). There is even a suggestion that mortality may ultimately be higher in the endovascular group. “If I was having an aneurysm repaired,” he added, “as a ‘fit’ 64 year old, I would choose open surgery.”

Morgan will be vehemently opposing this view, but, as ever at the CX Symposium, delegates will have the final word. “It will be an absolute pleasure engaging in debate about this proven twenty first century technique with a surgeon well known for his traditionalist views, and his Luddite views on aortic endografting!” Morgan told Vascular News.

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