Nieuwe argumenten voor endovasculaire versus open behandeling van patiënten met een aneurysma van de abdominale aorta

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