EVAR results publish in the New England Journal of Medicine

News release from NETSCC, HTA

13 August 2010

Long-term follow up results of the EndoVascular Aneurysm Repair (EVAR) trials, commissioned by the NIHR HTA programme have been published in the New England Journal of Medicine 20 May 2010.

The Vascular Surgery Research Group lead by Professor Roger Greenhalgh of Imperial College London, have been conducting the EVAR trials for the past ten years since recruitment commenced in 1999. It consist of two separate randomised trials for patients with abdominal aortic aneurysm considered fit (EVAR 1) or unfit for open repair (EVAR 2).

Abdominal aortic aneurysm is a swelling of the abdominal section of the aorta and rupture is a substantial cause of unexpected death in Britain. The open repair method is a 50 year old tried and trusted surgical treatment but it is a serious operation which involves a long stay in hospital and an increased risk of mortality. In some cases, frail patients are not considered fit enough for the open repair operation as it may be too much of a strain on their body and requires a general anaesthetic. EVAR is a minimally invasive technique and generally involves a shorter stay in hospital.

The mid-term results published in 2005 found that aneurysm-related mortality was lower for the endovascular-repair group; however during an additional five year follow-up, fatal endograft ruptures increased such that, overall, there was no significant difference between the two groups in the rate of death from the aneurysm or any other cause. Rates of graft-related complications and re-interventions were much higher with EVAR, and new complications continued to occur up to eight years, contributing to higher costs.

Professor Greenhalgh commented “These results confirm that careful long-term follow-up of new surgical innovations is essential. The results in the EVAR group showed that although aneurysm-related mortality looked promising at the beginning the benefits were lost by the end of the study.”

A joint title will be published in the HTA journal series in late 2011. View the full project details and sign up to receive an email alert when this publishes.

Notes for editors

 1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme commissions research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 530 issues published to date. The journal’s 2009 Impact Factor (4.197) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk

2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk

Contact details

Naomi Williams, Programme Manager (Communications)
Telephone: 02380 595 646, Email: N.E.Williams@southampton.ac.uk

Emma Sunderland, Assistant Programme Manager (Communications)
Telephone: 02380 599 094, Email: E.Sunderland@southampton.ac.uk

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