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Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial

Braithwaite, Bruce; Greenhalgh, Roger M.; Grieve, Richard; Hassan, Tajek B.; Moore, Fionna; Nicholson, Anthony A.; Soong, Chee V.; Heatley, Francine; Anjum, Aisha; Kalinowska, Gosia; Gomes, Manuel; Powell, Janet T.; Hinchliffe, Robert; Sweeting, Michael; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Roberts, Ian; Bell, Peter R.F.; Cheetham, Anne; Stephany, Jenny; Halliday, Alison W.; Warlow, Charles; Lamont, Peter; Moss, Jonathan; Tijssen, Jan; Ashleigh, Ray; Thompson, Matthew; Thompson, Luke; Cheshire, Nicholas J.; Boyle, Jonathan R.; Serracino-Inglott, Ferdinand; Hinchliffe, Robert J.; Bell, Rachel; Wilson, Noel; Bown, Matt; Dennis, Martin; Davis, Meryl; Howell, Simon; Wyatt, Michael G.; Valenti, Domenico; Bachoo, Paul; Walker, Paul; MacSweeney, Shane; Davies, Jonathan N.; Rittoo, Dynesh; Parvin, Simon D.; Yusuf, Waquar; Nice, Colin; Chetter, Ian; Howard, Adam; Chong, Patrick; Bhat, Raj; McLain, David; Gordon, Andrew; Lane, Ian; Hobbs, Simon; Pillay, Woolagasen; Rowlands, Timot...


Bruce Braithwaite

Roger M. Greenhalgh

Richard Grieve

Tajek B. Hassan

Fionna Moore

Anthony A. Nicholson

Chee V. Soong

Francine Heatley

Aisha Anjum

Gosia Kalinowska

Manuel Gomes

Janet T. Powell

Robert Hinchliffe

Michael Sweeting

Matt M. Thompson

Simon G. Thompson

Pinar Ulug

Ian Roberts

Peter R.F. Bell

Anne Cheetham

Jenny Stephany

Alison W. Halliday

Charles Warlow

Peter Lamont

Jonathan Moss

Jan Tijssen

Ray Ashleigh

Matthew Thompson

Luke Thompson

Nicholas J. Cheshire

Jonathan R. Boyle

Ferdinand Serracino-Inglott

Robert J. Hinchliffe

Rachel Bell

Noel Wilson

Matt Bown

Martin Dennis

Meryl Davis

Simon Howell

Michael G. Wyatt

Domenico Valenti

Paul Bachoo

Paul Walker

Shane MacSweeney

Jonathan N. Davies

Dynesh Rittoo

Simon D. Parvin

Waquar Yusuf

Colin Nice

Ian Chetter

Adam Howard

Patrick Chong

Raj Bhat

David McLain

Andrew Gordon

Ian Lane

Simon Hobbs

Woolagasen Pillay

Timothy Rowlands

Amin El-Tahir

John Asquith

Steve Cavanagh

Luc Dubois

Thomas L. Forbes

Emily Ashworth

Sara Baker

Hashem Barakat

Claire Brady

Joanne Brown

Christine Bufton

Tina Chance

Angela Chrisopoulou

Marie Cockell

Andrea Croucher

Leela Dabee

Nikki Dewhirst

Jo Evans

Andy Gibson

Siobhan Gorst

Moira Gough

Lynne Graves

Michelle Griffin

Josie Hatfield

Florence Hogg

Susannah Howard

Cián Hughes

David Metcalfe

Michelle Lapworth

Ian Massey

Teresa Novick

Gareth Owen

Noala Parr

David Pintar

Sarah Spencer

Claire Thomson

Orla Thunder

Tom Wallace

Sue Ward

Vera Wealleans

Lesley Wilson


© 2015 The Author. Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17] , P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI-0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or 4356 (95% CI 284, 8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective.


Braithwaite, B., Greenhalgh, R. M., Grieve, R., Hassan, T. B., Moore, F., Nicholson, A. A., …Wilson, L. (2015). Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: One-year outcomes from the IMPROVE randomized trial. European Heart Journal, 36(31), 2061-2069.

Journal Article Type Article
Acceptance Date Mar 26, 2015
Online Publication Date Apr 8, 2015
Publication Date Aug 14, 2015
Deposit Date Jul 9, 2018
Publicly Available Date Oct 27, 2022
Journal European Heart Journal
Print ISSN 0195-668X
Electronic ISSN 1522-9645
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 36
Issue 31
Pages 2061-2069
Keywords Aneurysm; Aorta; Rupture; Surgery; Stent grafts; Cost-effectiveness
Public URL
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© The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact

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