Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial

Bruce Braithwaite, Roger M. Greenhalgh, Richard Grieve, Tajek B. Hassan, Fionna Moore, Anthony A. Nicholson, Chee V. Soong, Francine Heatley, Aisha Anjum, Gosia Kalinowska, Manuel Gomes, Janet T. Powell, Robert Hinchliffe, Michael Sweeting, Matt M. Thompson, Simon G. Thompson, Pinar Ulug, Ian Roberts, Peter R.F. Bell, Anne CheethamJenny Stephany, Alison W. Halliday, Charles Warlow, Peter Lamont, Jonathan Moss, Jan Tijssen, Ray Ashleigh, Matthew Thompson, Luke Thompson, Nicholas J. Cheshire, Jonathan R. Boyle, Ferdinand Serracino-Inglott, Robert J. Hinchliffe, Rachel Bell, Noel Wilson, Matt Bown, Martin Dennis, Meryl Davis, Simon Howell, Michael G. Wyatt, Domenico Valenti, Paul Bachoo, Paul Walker, Shane MacSweeney, Jonathan N. Davies, Dynesh Rittoo, Simon D. Parvin, Waquar Yusuf, Colin Nice, Ian Chetter, Adam Howard, Patrick Chong, Raj Bhat, David McLain, Andrew Gordon, Ian Lane, Simon Hobbs, Woolagasen Pillay, Timothy Rowlands, Amin El-Tahir, John Asquith, Steve Cavanagh, Luc Dubois, Thomas L. Forbes, Emily Ashworth, Sara Baker, Hashem Barakat, Claire Brady, Joanne Brown, Christine Bufton, Tina Chance, Angela Chrisopoulou, Marie Cockell, Andrea Croucher, Leela Dabee, Nikki Dewhirst, Jo Evans, Andy Gibson, Siobhan Gorst, Moira Gough, Lynne Graves, Michelle Griffin, Josie Hatfield, Florence Hogg, Susannah Howard, Cián Hughes, David Metcalfe, Michelle Lapworth, Ian Massey, Teresa Novick, Gareth Owen, Noala Parr, David Pintar, Sarah Spencer, Claire Thomson, Orla Thunder, Tom Wallace, Sue Ward, Vera Wealleans, Lesley Wilson, Janet Woods, Ting Zheng

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Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI-0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or 4356 (95% CI 284, 8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective.

Original languageEnglish
Pages (from-to)2061-2069
Number of pages9
JournalEuropean Heart Journal
Issue number31
StatePublished - Aug 14 2015
Externally publishedYes


  • Aneurysm
  • Aorta
  • Cost-effectiveness
  • Rupture
  • Stent grafts
  • Surgery


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