Details of HTA project
Last updated: 26 August 2008 - Next update due: 2 September 2008
Research type: |
NICE Technology Assessment Report (TAR) |
Project title: |
Endovascular stents for abdominal aortic aneurysms: a systematic review and economic model |
Link to NICE guidance page |
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Project ref: |
07/09/01 |
Cost: |
This project has been commissioned by the HTA programme on behalf of the National Institute for Health and Clinical Excellence on a call-off contract basis. |
Chief Investigator : |
NHS Centre for Reviews and Dissemination (CRD), University of York |
Start Date: |
August 2007. |
Publication date: |
June 2009. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
The aorta is a large blood vessel (artery) that carries oxygenated blood from the heart to the rest of the body. Aortic aneurysms occur when the wall of the aorta is weakened by the constant pressure of blood passing through it, leading to the formation of a balloon-like projection. This in turn leads to stretching of the vessel wall and an increase in tension that can result in rupture. Rupture produces massive internal bleeding with an overall mortality rate of approximately 80%. Even if patients undergo emergency surgery, only about half survive. Most aneurysms are in the lower (abdominal) section of the aorta and are known as abdominal aortic aneurysms (AAAs). Most AAAs do not produce any symptoms and are discovered by chance during clinical examination or by imaging tests (most people with AAAs also have other problems). When AAAs are small, the risk of rupture is low, but over time the size of the aneurysm, and hence the risk of rupture, is likely to increase. The risk of rupture may be as high as 25% per year for aneurysms with a diameter greater than 6 cm. AAAs can be treated surgically to prevent rupture. The standard method of surgical repair involves making a large cut in the abdomen and replacing the damaged section of the aorta with a prosthetic graft. This procedure, known as 'open repair', involves some risk, particularly as patients with AAA are often elderly with heart, kidney or other disease. Some patients with AAAs are not considered fit enough to undergo this type of surgery. Endovascular aneurysm repair (EVAR) is a less invasive technique that is considered to be less traumatic for the patient and to lead to shorter hospital stays. EVAR involves the use of an endovascular ('inside blood vessels') stent-graft. The stent-graft is a tube made of material such as polytetrafluoroethylene supported by a thin metal framework (stent). The stent-graft is inserted through a small incision in the femoral artery in the groin, carried to the site of the aneurysm using catheters and guidewires and placed in position under X-ray guidance. Once in position, the stent-graft is expanded and attaches to the wall of the aorta. The graft is stronger than the weakened aorta and allows blood to pass through it without creating pressure on the aneurysm. The purpose of this project is to assess how effective and safe EVAR is and whether it is a cost-effective procedure for the repair of AAAs. A further objective of our review is to try to identify criteria for selecting patients for whom EVAR would be particularly appropriate. |
Abstract: |
The aim of this project is to determine the clinical and cost-effectiveness of endovascular stent-grafts for repair of infrarenal abdominal aortic aneurysms across a range of patient risk levels, including those who are considered suitable for open repair and those who are not. The objective of this assessment is to determine the clinical and cost-effectiveness of endovascular stent-grafts for repair of infrarenal abdominal aortic aneurysms in patients at varying levels of risk, including those who are appropriate for open repair and those who are not. The assessment will build on the information already available, including recent systematic reviews10-13 There remains uncertainty, however, about longer-term outcomes, about the variables and risk factors that influence the effectiveness and safety of EVAR and whether there are subgroups of patients for whom EVAR is particularly appropriate. The NIHR HTA programme commissioned this report on behalf of the National Institute for Health and Clinical Excellence. |
NRR* number, if applicable: |
N0484196303 (*National Research Register) |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/1678 |
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