In patients with a ruptured abdominal aortic aneurysm, an endovascular strategy is associated with a better survival rate, higher quality adjusted life years, and decreased hospital costs compared with open repair, according to a study in the BMJ

Janet T. Powell, MD, PhD, FRCPath, of the Vascular Surgery Research Group at Imperial College London, and colleagues at 30 vascular centers conducted a 3-year randomized controlled trial in which 613 patients older than age 50 (77% male) and clinically diagnosed with a ruptured abdominal aortic aneurysm were treated with either endovascular or open repair. In this study, which ranged from September 2009 until July 2016, total mortality was the primary outcome and secondary outcomes included aneurysm-related reinterventions post-repair, quality of life, and hospital costs up to 3 years. 

In total, 82% of patients across both groups had emergency rupture repair. Of the 316 patients in the endovascular repair group, 87% had aortic-iliac aneurysm rupture. The primary outcome at year 3 resulted in 151 deaths from the endovascular group and 165 from the open repair group (odds ratio, 0.73). By year 7, no significant differences were observed in mortality rates (hazard ratio, 0.92). 

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In the secondary analysis, the authors reported no major differences in reintervention rates between groups (hazard ratio, 1.02) but noted that open repair patients were hospitalized an average of 6.1 more days compared with patients receiving endovascular strategy treatment. Endovascular strategy was associated with an increase in quality of life and decrease in average hospital costs, which averaged $3439 less than for open repair patients. 

The investigators noted the limitations associated with being the first specified study of its kind but added that this pragmatic approach provides new insight on treatment methods and health economics. 

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“This mid-term follow-up provides convincing support for the benefits of an endovascular strategy versus open repair to treat patients with ruptured abdominal aortic aneurysm,” stated the researchers. “At 3 years, the endovascular strategy offers an increase in QALYs, without the excess of reinterventions, and is cost effective.” 


  1. Powell JT; IMPROVE Trial Investigators. Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial. BMJ. 2017 Nov 14. doi: 10.1136/bmj.j4859