The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress.

OBJECTIVES The endovascular aneurysm repair (EVAR) trials aim to assess the efficacy of EVAR in the treatment of AAA in terms of mortality, quality of life, durability and cost-effectiveness. DESIGN Male and female patients aged at least 60 years with an AAA diameter measuring at least 5.5 cm on a computed tomography (CT) scan are assessed for anatomical suitability for EVAR. Suitable patients are offered entry either into EVAR Trial 1 if they are considered fit for conventional open repair or EVAR Trial 2 if they are considered unfit. EVAR 1 randomly allocates patients to EVAR or open repair and EVAR 2 randomly allocates patients to EVAR with best medical treatment or best medical treatment alone. Target recruitment for EVAR Trials 1 and 2 is 900 and 280 patients, respectively. PROGRESS Recruitment began in September 1999 and there are currently 40 UK centres participating in the trials. Monthly targets are being exceeded in EVAR Trial 1 with 1037 patients randomised by October 2003. EVAR Trial 2 is also meeting monthly targets with a total of 319 patients randomised. When recruitment closes in December 2003 patients will need to be followed for at least 1 year from their operation. Publication of full results for both trials is expected in mid 2005.

[1]  A. Garratt,et al.  A New Approach to the Measurement of Quality of Life: The Patient‐Generated Index , 1994, Medical care.

[2]  D. Streiner,et al.  Health Measurement Scales: A practical guide to thier development and use , 1989 .

[3]  Pascal Desgranges,et al.  Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience , 2000 .

[4]  P. Gaines,et al.  Short-term (30-day) outcome of endovascular treatment of abdominal aortic aneurism: results from the prospective Registry of Endovascular Treatment of Abdominal Aortic Aneurism (RETA). , 2001, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[5]  A. Nasim,et al.  Endovascular repair of abdominal aortic aneurysm: An initial experience , 1996, The British journal of surgery.

[6]  R. Cuming,et al.  Assessment of feasibility for endovascular prosthetic tube correction of aortic aneurysm , 1995, The British journal of surgery.

[7]  M. Abdalla,et al.  The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? , 1993, BMJ.

[8]  R. Greenhalgh The Durability of Vascular and Endovascular Surgery , 1999 .

[9]  A. R. Brady,et al.  Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. , 2002 .

[10]  Paul Kind,et al.  A social tariff for EuroQol: results from a UK general population survey , 1995 .

[11]  A. Williams EuroQol : a new facility for the measurement of health-related quality of life , 1990 .

[12]  M J Al,et al.  Costs, effects and C/E-ratios alongside a clinical trial. , 1994, Health economics.

[13]  Endoluminal transfemoral abdominal aortic aneurysm repair with aorto‐uni‐iliac graft and femorofemoral bypass , 1995, The British journal of surgery.

[14]  R J Lilford,et al.  Trials and fast changing technologies: the case for tracker studies , 2000, BMJ : British Medical Journal.

[15]  Andrew Briggs,et al.  Missing... presumed at random: cost-analysis of incomplete data. , 2003, Health economics.

[16]  Inpatient costs of routine endovascular repair of abdominal aortic aneurysm. , 2001, Academic radiology.

[17]  D G Altman,et al.  Analysis of serial measurements in medical research. , 1990, BMJ.

[18]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[19]  S. Money,et al.  Hospital cost of endovascular versus open repair of abdominal aortic aneurysms: a multicenter study. , 2000, Journal of vascular surgery.

[20]  A. R. Brady,et al.  Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms , 1998, The Lancet.

[21]  K. Kent,et al.  The cost-effectiveness of endovascular repair versus open surgical repair of abdominal aortic aneurysms: A decision analysis model. , 1999, Journal of vascular surgery.

[22]  M Johannesson,et al.  On the decision rules of cost-effectiveness analysis. , 1993, Journal of health economics.

[23]  M. Abdalla,et al.  SF 36 health survey questionnaire: I. Reliability in two patient based studies. , 1994, Quality in health care : QHC.

[24]  D. Puppala,et al.  Is preoperative cardiac evaluation for abdominal aortic aneurysm repair necessary? , 1997, Journal of vascular surgery.

[25]  D. C. Brewster,et al.  Presentation and patterns of aortic aneurysms in young patients. , 1994, Journal of vascular surgery.

[26]  M. Abdalla,et al.  SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. , 1994, Quality in health care : QHC.

[27]  R J Cook,et al.  Using inverse-weighting in cost-effectiveness analysis with censored data , 2002, Statistical methods in medical research.

[28]  G. Gazelle,et al.  Abdominal aortic aneurysms: cost-effectiveness of elective endovascular and open surgical repair. , 2002, Radiology.

[29]  H. Myhre,et al.  The need for clinical trials of endovascular abdominal aortic aneurysm stent-graft repair: The EUROSTAR Project. EUROpean collaborators on Stent-graft Techniques for abdominal aortic Aneurysm Repair. , 1997 .

[30]  J. Parodi,et al.  Transfemoral intraluminal graft implantation for abdominal aortic aneurysms , 1991, Annals of vascular surgery.

[31]  F. Fowkes,et al.  Increasing incidence of aortic aneurysms in England and Wales. , 1989, BMJ.