A session taking place at this year’s Charing Cross Vascular Symposium CX 34, dealt with the findings from the world’s first multicentre, randomised, controlled trial comparing Endovascular Aneurysm repair (EVAR) and open repair for ruptured abdominal aortic aneurysms.
The Dutch AJAX trial results demonstrated no difference between EVAR and open repair in emergent cases.
In the same session, the audience also heard an outline of the SWIFT (Swiss ruptured aneurysm Favourable Transport) study ostensibly on the effect of transport on ruptured aneurysm treatment outcomes. The Swiss study offers up contrasting data sets from Bern and Zurich, one centre strongly favouring open repair (Bern, 96%), while in Zurich the centre claims repair other than by EVAR is unethical.
The AJAX study is an obvious place to look for the answer, but even here the open group performed better than anticipated. According to the report’s presenter, Ron Balm; “This could be attributable to the introduction of the trial with optimised logistics and patient care such as the pre-operative CTA and centralisation.”
So, while AJAX results shed some light on treatment for ruptured aneurysms, many questions still remain unanswered, not least because of additional factors and inter-centre discrepancies between EVAR and open repair in Switzerland.
The CX34 report can be found here.