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@article{Ulug:2018:10.3310/hta22310,
author = {Ulug, P and Hinchliffe, RJ and Sweeting, MJ and Gomes, M and Thompson, MT and Thompson, SG and Grieve, RJ and Ashleigh, R and Greenhalgh, RM and Powell, JT},
doi = {10.3310/hta22310},
journal = {Health Technology Assessment},
title = {Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT},
url = {http://dx.doi.org/10.3310/hta22310},
volume = {22},
year = {2018}
}

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TY  - JOUR
AB  - BackgroundRuptured abdominal aortic aneurysm (AAA) is a common vascular emergency. The mortality from emergency endovascular repair may be much lower than the 40–50% reported for open surgery.ObjectiveTo assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality (including costs and cost-effectiveness) among patients with a suspected ruptured AAA.DesignRandomised controlled trial, with computer-generated telephone randomisation of participants in a 1 : 1 ratio, using variable block size, stratified by centre and without blinding.SettingVascular centres in the UK (n = 29) and Canada (n = 1) between 2009 and 2013.ParticipantsA total of 613 eligible participants (480 men) with a ruptured aneurysm, clinically diagnosed at the trial centre.InterventionsA total of 316 participants were randomised to the endovascular strategy group (immediate computerised tomography followed by endovascular repair if anatomically suitable or, if not suitable, open repair) and 297 were randomised to the open repair group (computerised tomography optional).Main outcome measuresThe primary outcome measure was 30-day mortality, with 30-day reinterventions, costs and disposal as early secondary outcome measures. Later outcome measures included 1- and 3-year mortality, reinterventions, quality of life (QoL) and cost-effectiveness.ResultsThe 30-day mortality was 35.4% in the endovascular strategy group and 37.4% in the open repair group [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.66 to 1.28; p = 0.62, and, after adjustment for age, sex and Hardman index, OR 0.94, 95% CI 0.67 to 1.33]. The endovascular strategy appeared to be more effective in women than in men (interaction test p = 0.02). More discharges in the endovascular strategy group (94%) than in the open repair group (77%) were directly to home (p < 0.001). Average 30-day costs
AU  - Ulug,P
AU  - Hinchliffe,RJ
AU  - Sweeting,MJ
AU  - Gomes,M
AU  - Thompson,MT
AU  - Thompson,SG
AU  - Grieve,RJ
AU  - Ashleigh,R
AU  - Greenhalgh,RM
AU  - Powell,JT
DO  - 10.3310/hta22310
PY  - 2018///
SN  - 1366-5278
TI  - Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT
T2  - Health Technology Assessment
UR  - http://dx.doi.org/10.3310/hta22310
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000433568400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/60895
VL  - 22
ER  -

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