Legemate D A
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Epidemiologie, Postbus 22.660, 1100 DD Amsterdam.
Ned Tijdschr Geneeskd. 2006 Mar 25;150(12):653-6.
Recent randomised trials have compared conventional and endovascular repair of asymptomatic abdominal aortic aneurysms (DREAM and EVAR I trials), and endovascular repair with no intervention in high-risk patients (EVAR 2 trial). DREAM and EVAR I showed that endovascular repair is associated with lower perioperative mortality, but overall survival is not improved after mid-term follow-up. EVAR 2 showed that high-risk patients do not benefit from elective endovascular repair. It can be concluded that relatively young and low-risk patients should be treated with open repair and that conservative treatment may be appropriate for high-risk patients. Between these extremes is a large group ofpatients who may benefit from endovascular repair. However, long-term follow-up data are not yet available and costs for endovascular therapy are substantial.
近期的随机试验比较了无症状腹主动脉瘤的传统修复术和血管内修复术（DREAM试验和EVAR I试验），以及高危患者血管内修复术与不干预的情况（EVAR 2试验）。DREAM试验和EVAR I试验表明，血管内修复术与较低的围手术期死亡率相关，但中期随访后总体生存率并未提高。EVAR 2试验表明，高危患者无法从择期血管内修复术中获益。可以得出结论，相对年轻和低风险的患者应采用开放修复术治疗，而保守治疗可能适用于高危患者。在这两个极端之间，有一大组患者可能从血管内修复术中获益。然而，尚无长期随访数据，且血管内治疗费用高昂。
