University of Colorado School of Medicine, Denver, CO, USA.
Semin Vasc Surg. 2012 Mar;25(1):39-48. doi: 10.1053/j.semvascsurg.2012.03.005.
Development of endovascular abdominal aortic aneurysms repair (EVAR), now in its 4th decade, has involved at least 16 different devices, not counting major modifications of some, only 4 of which have emerged from clinical trials and gained US Food and Drug Administration approval. The main impetus behind EVAR has been its potential for significantly reducing procedural mortality and morbidity, but it was also expected to speed recovery and reduce costs through decreased use of hospital resources. At the outset, EVAR was touted as a better alternative to OPEN in high-risk patients with large abdominal aortic aneurysms, and to "watchful waiting" (periodic ultrasound surveillance) for those with small abdominal aortic aneurysms. This new technology has evoked a mixed response with enthusiasts and detractors debating its pros and cons. Bias and conflict of interest exist on both sides. This review will attempt to present a balanced review of the development and current status of this controversial competition between EVAR and OPEN, comparing them in terms of the following key considerations: mortality and morbidity, complications, failure modes and durability, and costs.
血管内腹主动脉瘤修复术（EVAR）的发展已有 40 余年历史，至少涉及 16 种不同的器械，其中还不包括某些器械的重大改进，只有 4 种器械通过临床试验并获得美国食品和药物管理局批准。EVAR 的主要动力是其降低手术死亡率和发病率的潜力，但也有望通过减少医院资源的使用来加快康复速度并降低成本。起初，EVAR 被吹捧为治疗大型腹主动脉瘤高危患者的一种优于开放式手术的选择，也可用于治疗小型腹主动脉瘤的患者进行“观察等待”（定期超声监测）。这项新技术引起了支持者和反对者的不同反应，双方就其优缺点展开了辩论。双方都存在偏见和利益冲突。本文将尝试对 EVAR 和 OPEN 之间这一备受争议的竞争的发展和现状进行平衡评估，从以下关键方面对它们进行比较：死亡率和发病率、并发症、失效模式和耐久性以及成本。
