CORRESPONDENCE

Prophylactic Endovascular Repair of SmallAbdominal Aortic Aneurysm

We read with great interest the article by Zarins et al.1

They reviewed all patients with small abdominal aorticaneurysm treated with a stent graft in the multicenterAneuRx clinical trial. A subgroup of patients who metthe age and aneurysm size inclusion criteria of the UKSmall Aneurysm Trial (EVARmatch) were compared tothepublished resultsof the surveillancepatient cohortoftheUKSmallAneurysmTrial.While EVAR trials 1 and 2suggested endovascular repair may have no advantageover open repair (for patients considered fit for openrepair) or no intervention (for patients of poor healthstatus considered unfit for open repair) with regard tooverall survival, this form of treatment has beenadvocated for small abdominal aortic aneurysms.2–4

Zarins et al. made every effort to match the AneuRxsmall aneurysm patient population to the inclusioncriteria of the UK Small Aneurysm Trial, but there wereimportant differences between the EVARmatch and UKsurveillance groups with respect to age, comorbiditiesand genderdistribution. Itwould be interesting to knowmorbidities, including total or fatal ruptures andaneurysm related or all-cause deaths, adjusted for age,comorbidities, and gender. Although we greatlyappreciate the ‘virtual’ randomized controlled trial byZarins et al., we strongly support an ‘actual’ trial of openversus endoluminal repair of small aortic aneurysms.

H. Takagi*, T. UmemotoDepartment of Cardiovascular Surgery,

Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho,Sunto-gun, Shizuoka 411-8611, JapanE-mail address. kfgth973@ybb.ne.jp

References

1 Zarins CK, Crabtree T, Arko FR, Heikkinen MA, Bloch DA,Ouriel K et al. Endovascular repair or surveillance of patientswith small AAA. Eur J Vasc Endovasc Surg 2005;29:496–503.

*Corresponding author. Dr H. Takagi, MD, PhD, Department ofCardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa,Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan.

1078–5884/000562+ 02 $35.00/0 q 2006 Published by Elsevier Ltd.

2 EVAR Trial Participants. Endovascular aneurysm repair versusopen repair in patients with abdominal aortic aneurysm (EVARtrial 1): randomised controlled trial. Lancet 2005;365:2179–2186.

3 EVAR Trial Participants. Endovascular aneurysm repair andoutcome in patients unfit for open repair of abdominal aorticaneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005;365:2187–2192.

4 Takagi H, Umemoto T. Endovascular repair of abdominal aorticaneurysm. Lancet 2005;366:890.

Accepted 23 December 2005Available online 14 February 2006

doi:10.1016/j.ejvs.2005.12.020, available online at

http://www.sciencedirect.com on

EJVES: Response to Letter to the Editor—December 6, 2005Endovascular Repair or Surveillance of Patientwith Small AAA

Dear Editor

We agree with Drs Takagi and Umemoto that endovas-cular repair of small abdominal aortic aneurysmsappears to improve outcome compared to ultrasoundsurveillance and that aprospective randomized trialwillbeneeded toconfirmthishypothesis.Ourcomparisonofa matched cohort of patients with small aneurysmstreatedwithendovascular repair inaprospectiveclinicaltrial to patients with small aneurysms randomized tosurveillance in the UK small aneurysm trial does notconstitute a ‘virtual’ randomized controlled trial.However, it does provide evidence that early endovas-cular repair of small aortic aneurysms may reduce therisk of fatal aneurysm rupture and aneurysm-relateddeath and improve overall patient survival compared toultrasound surveillance.1

As Dr Takagi notes, there were importantdifferences between the EVARmatch and UKsurveillance groups with respect to age, comorbid-ities and gender. Patients treated with EVAR wereolder, had more comorbidities and had larger

Eur J Vasc Endovasc Surg 31, 562–563 (2006)

doi:10.1016/j.ejvs.2005.12.021, available online at http://www.sciencedirect.com on