Speaking on the last day of the 31st CX Symposium, Janet Powell of Imperial College London, UK, presented the rationale for the new IMPROVE (Immediate management of the patient with rupture: open vs. endovascular repair) trial.
“I’m sure we all know, and agree, that ruptured aortic aneurysm has a grim prognosis,” she said. “In the past, more than 85% of patients with a rupture has died.”
She presented familiar data from the UK Small Aneurysm trial, showing that over half who made it to hospital died there without any surgery, and 54% of those who did make it to surgery were dead within 30 days.
But the ten years since this trial have seen the rise of endovascular techniques. “Based on selected patients and selected publications, systematic reviews have suggested that if you use endovascular repair, you could reduce the operative mortality from about 48% to 25%,” she said.
“However, one small, randomised trial – the only one published to date – showed no difference in mortality between open and endovascular repair. Therefore, there’s a general consensus that we need some definitive randomised trials.”
The IMPROVE trial has therefore been established. Patients in the trial will be randomised before computed tomography scan, either to open repair, where computed tomography is held to be inessential, or to an urgent scan and endovascular repair.
IMPROVE is open to recruitment from centres across Europe.
“This trial will answer a number of questions and can inform the provision of future services,” said Powell.