The Endovasculaire vs Chirurgie dans les Anevrysmes Rompus PROTOCOL trial update

Endovascular aortic repair (EVAR) treatment for ruptured aortoiliac aneurysms (rAIA) avoids the additional surgical insult to physiology that comes with laparotomy and open repair (OR). In systematic reviews, the pooled mortality rate from rAIA after EVAR is around 20% and morbidity around 40%. The proportion of patients with rAIA treated by EVAR is steadily increasing, as most centers are adopting all EVAR as a first line therapy. However, two trials, one randomized (n = 32) and one nonrandomized, failed to demonstrate any benefit of EVAR to OR. The multicentric randomized study named ECAR (for Endosvasculaire vs Chirurgie clans les Anevrysmes Rompus) was setup on 160 patients to compare the EVAR vs OR in rAIA. The primary outcome is mortality at I month. The study started in January 2008 and is still in progress. (J Vasc Surg 2010;51:267-70.)