In Reply: As Drs Kapoor and Kapoor note, the EVAR 2 trial1 evaluated patients considered unfit for open AAA repair, comparing EVAR with observation. There was no survival benefit seen with randomization to EVAR. However, it is impossible to draw firm conclusions from this small trial because of several flaws.
In the group randomized to EVAR (n = 166), 9 aortic ruptures and 14 deaths occurred before repair. The median time to repair was 57 days despite a median AAA diameter of 6.4 cm (range, 6.0-7.4 cm). Perioperative mortality in those randomized to EVAR was 9%. Of those randomized to medical management, 27% crossed over and underwent EVAR, with an operative mortality of only 3.7%.
Schermerhorn M. Endovascular Aortic Aneurysm Repair—Reply. JAMA. 2010;303(11):1035-1036. doi:10.1001/jama.2010.155