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EVAR vs Open AAA Repair — FRCA Final MCQ

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ModeratePerioperative MedicineEVAR vs Open AAA RepairFRCA Final

A 68-year-old man (ASA III) has a 6.2 cm asymptomatic infrarenal abdominal aortic aneurysm. His anatomy is suitable for standard endovascular aneurysm repair (EVAR), and the multidisciplinary team considers him fit for either EVAR or open repair. Which statement most accurately describes 30-day mortality after elective EVAR compared with open repair?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Thirty-day mortality is lower with EVAR, approximately 1.7% versus 4.7%

Explanation lettering: D = shown as B · B = shown as D

Elective EVAR has lower early operative mortality than open repair. In the UK EVAR-1 randomised trial, 30-day mortality was 1.7% after EVAR and 4.7% after open repair, corresponding to an approximately two-thirds relative reduction. Therefore, B is correct; A and C reverse or deny the observed difference. The benefit was not confined to patients aged 80 years or more, excluding D. E is also incorrect: this evidence concerns elective unruptured AAA, while the IMPROVE trial of suspected ruptured AAA did not demonstrate a statistically significant 30-day mortality reduction with an endovascular strategy. The early mortality benefit should not be equated with overall superiority: EVAR requires lifelong surveillance and has more late aneurysm-related complications and reinterventions. NICE therefore does not recommend elective EVAR solely because the anatomy is suitable.

Reference: NICE. Abdominal aortic aneurysm: diagnosis and management (NG156), Rationale and impact—open surgical repair, standard EVAR or conservative management. 2020. https://www.nice.org.uk/guidance/ng156/chapter/Rationale-and-impact