Editor—The title and interpretation of the EVAR trial results in the POEM are misleading and incorrect.1 Mortality figures were quoted both as aneurysm related and all cause deaths. The 30 day mortality was 1.7% in the EVAR group, which is significantly lower than 4.7% in the open repair group. Surprisingly, the POEM somehow interpreted 30 day mortality to be less than 1% for both groups, which is clearly an error. The confidence intervals (odds ratio 0.35, 95% confidence interval 0.16 to 0.77, P = 0.009) make type I error unlikely. If preintervention deaths are added to the figures 30 day mortality was calculated at 3.5% for endovascular repair and 7.1% for open surgery.2
The advantage of endovascular repair is sustained at four years, with 4% aneurysm related deaths in the EVAR group compared with 7% in the open repair group. This confers a 3% absolute reduction in aneurysm related mortality. The all cause mortality rate was comparable in both groups at four years.
Endovascular repair offers a 30 day lower risk treatment compared with open surgery in patients who are medically fit with an abdominal aortic aneurysm. Compared with open repair, endovascular repair offers no advantage with respect to all cause mortality and health related quality of life; and is more expensive; however, it confers a 3% improved aneurysm related survival which persists at four years.
The POEM's message that endovascular repair is worse than open repair is inaccurate and not evidence based.
Competing interests: None declared.
References
- 1.Endovascular repair is worse than open repair of abdominal aortic aneurysms. BMJ 2005;331: 0-f. (24 September.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005;365: 2179-86. [DOI] [PubMed] [Google Scholar]