French trial ACE results indicate that EVAR offers no benefits over open repair at five years


The UK EVAR and Dutch DREAM trial results have already been published. However, the French ACE trial has experienced several years of delay and been beleaguered by financial difficulties related to stent grafts for the EVAR procedure. The results of this long-awaited trial show that EVAR offers no advantages over open surgery in patients who are low risk for the latter procedure and who have a favourable anatomy for EVAR at five years.

Results of the ACE (Anevrysme de l’aorte abdominale, chirurgie versus endoprothese) trial were presented by Jean-Pierre Becquemin, HenriMondor Hospital, Créteil, France, at the 2010 European Society for Vascular Surgery annual meeting in Amsterdam, The Netherlands.


The ACE trial is a multicentre, prospective randomised trial aimed at assessing the results of EVAR and of open surgery in relatively good-risk patients presenting with an asymptomatic abdominal aortic or aortoiliac aneurysm.


Becquemin concluded that in patients with a low risk for open surgery and a favourable anatomy for EVAR, EVAR offers no advantage in terms of mortality and prevention of aneurysm rupture. Vascular re-interventions and minor complications are in the same range, although different in nature.


The Dutch Randomized Endovascular Aneurysm Repair (DREAM) trial confirmed that open surgical repair and endovascular repair of abdominal aortic aneurysm have similar six-year survival rates, but endovascular repair requires more secondary interventions. Results of the DREAM study mirror those of the UK EVAR 1 trial, which showed that aneurysm-related mortality at four years was superior for EVAR, but that both all-cause mortality and aneurysm-related mortality rates even out over the long run because endovascular repair leads to more secondary re-interventions.


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