***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Compare long-term results of  endovascular treatment  and  st and ard open repair of abdominal aortic aneurysms in a multicenter , concurrent-controlled trial . METHODS 334 subjects were treated with st and ard open repair ( control , n = 99 ) or the original EXCLUDER Bifurcated Endoprosthesis ( test , n = 235 ) . Five-year clinical evaluations and corelab radiographic results are analyzed . RESULTS Overall and aneurysm-related survival are similar . There have been ten open conversions , most frequently for enlarging sacs without endoleak . Two patients died after conversion . Including re interventions and complications of re interventions as adverse events , there is significant , persistent long-term reduction in major adverse events . At 5 years , corelab reported 0 % limb narrowing , 0 % trunk migration , 0 % component ( contralateral leg , aortic extender , and iliac extender ) migration , 0 % fracture , endoleak in 3 % ( 2 type II/68 ) , and aneurysm growth ( > 5 mm compared to baseline ) in 38 % ( 30/78 ) of the test group . There are no aneurysm ruptures in either test or control group . CONCLUSIONS After 5 years follow-up , endovascular repair is a safer and effective treatment compared with open surgical repair for abdominal aortic aneurysms . Major adverse events are less frequent with the endograft despite the need for late re interventions . Aneurysm expansion is observed in nearly two-fifths of patients but is not associated with endoleak or aneurysm rupture . Multicenter clinical trials are evaluating a newer version of this device design ed to avoid this high rate of sac expansion After the introduction of endovascular repair of abdominal aortic aneurysms ( AAA ) , both benefits and drawbacks of this new technique have been reported . To assess whether the new technique is an adequate substitute of conventional AAA repair , a r and omised study is due . The Dutch R and omised Endovascular Aneurysm Management ( DREAM ) trial is a r and omised multicenter trial enrolling patients eligible for elective treatment of infrarenal AAAs . In this study , the cost-effectiveness of endovascular aneurysm repair ( EAR ) is compared with that of conventional transabdominal surgery , in patients that are considered suitable for both types of treatment . The primary endpoint is combined operative mortality and morbidity . Secondary endpoints and additional assessment s include event free survival , quality of life , length of hospital stay and costs . It is expected that the DREAM-trial will lead to a safe and controlled introduction of a new technology . Also , the medical community will obtain valid scientific evidence of the merits of endovascular AAA repair . Finally , policy makers will be provided with accurate cost-effectiveness data for the Dutch healthcare system . The aim of the present paper is to describe the background , methods and design of the DREAM-trial OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of a novel endovascular graft for elective treatment of infrarenal abdominal aortic aneurysm . The device is a modular bifurcated system with nitinol/exp and ed polytetrafluoroethylene components and a smaller profile than currently approved devices . METHODS In a multicenter , concurrent controlled phase II trial , 334 patients underwent treatment with the Excluder bifurcated endoprosthesis ( test , n = 235 ; W. L. Gore & Associates , Inc , Sunnyvale , Calif ) or with st and ard open repair ( control , n = 99 ) . Preoperative characteristics , perioperative variables , follow-up clinical evaluations , and radiographic examination results through the first 2 years were analyzed with univariable and multivariable statistics . RESULTS Patients in the test group had less blood loss ( 310 + /- 19 mL versus 1590 + /- 124 mL ; P < .0001 ) , fewer homologous transfusions ( 6 % versus 32 % ; P < .0001 ) , and shorter lengths of stay ( 2.0 + /- 0.1 days versus 9.8 + /- 1.4 days ; P < .0001 ) . Early major adverse events were markedly reduced in the test group ( 14 % versus 57 % ; P < .0001 ) , and this difference persisted at 2 years . No difference was seen in survival rate ( P = .13 ) . In the first 2 years , no deployment failure , early conversion , or aneurysm rupture occurred . At the 2-year timepoint , core laboratory read trunk migration in 1 % , limb migration in 1 % , limb narrowing in 1 % , endoleak in 20 % , and aneurysm growth in 14 % . One wire discontinuity ( 0.6 % ) was identified in a discharge film . A 7 % annual reintervention rate was seen in the test group in the first 2 years . SUMMARY The test device is a safe and effective treatment compared with open surgical repair for infrarenal abdominal aortic aneurysm . The most striking benefits are reduced blood loss , fewer complications , and faster recovery . Two-year survival rate was similar BACKGROUND Although the initial results of endovascular repair of abdominal aortic aneurysms were promising , current evidence from controlled studies does not convincingly show a reduction in 30-day mortality relative to that achieved with open repair . METHODS We conducted a multicenter , r and omized trial comparing open repair with endovascular repair in 345 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable c and i date s for both techniques . The outcome events analyzed were operative ( 30-day ) mortality and two composite end points of operative mortality and severe complications and operative mortality and moderate or severe complications . RESULTS The operative mortality rate was 4.6 percent in the open-repair group ( 8 of 174 patients ; 95 percent confidence interval , 2.0 to 8.9 percent ) and 1.2 percent in the endovascular-repair group ( 2 of 171 patients ; 95 percent confidence interval , 0.1 to 4.2 percent ) , result ing in a risk ratio of 3.9 ( 95 percent confidence interval , 0.9 to 32.9 ) . The combined rate of operative mortality and severe complications was 9.8 percent in the open-repair group ( 17 of 174 patients ; 95 percent confidence interval , 5.8 to 15.2 percent ) and 4.7 percent in the endovascular-repair group ( 8 of 171 patients ; 95 percent confidence interval , 2.0 to 9.0 percent ) , result ing in a risk ratio of 2.1 ( 95 percent confidence interval , 0.9 to 5.4 ) . CONCLUSIONS On the basis of the overall results of this trial , endovascular repair is preferable to open repair in patients who have an abdominal aortic aneurysm that is at least 5 cm in diameter . Long-term follow-up is needed to determine whether this advantage is sustained CONTEXT Limited data are available to assess whether endovascular repair of abdominal aortic aneurysm ( AAA ) improves short-term outcomes compared with traditional open repair . OBJECTIVE To compare postoperative outcomes up to 2 years after endovascular or open repair of AAA in a planned interim report of a 9-year trial . DESIGN , SETTING , AND PATIENTS A r and omized , multicenter clinical trial of 881 veterans ( aged > or = 49 years ) from 42 Veterans Affairs Medical Centers with eligible AAA who were c and i date s for both elective endovascular repair and open repair of AAA . The trial is ongoing and this report describes the period between October 15 , 2002 , and October 15 , 2008 . INTERVENTION Elective endovascular ( n = 444 ) or open ( n = 437 ) repair of AAA . MAIN OUTCOME MEASURES Procedure failure , secondary therapeutic procedures , length of stay , quality of life , erectile dysfunction , major morbidity , and mortality . RESULTS Mean follow-up was 1.8 years . Perioperative mortality ( 30 days or inpatient ) was lower for endovascular repair ( 0.5 % vs 3.0 % ; P = .004 ) , but there was no significant difference in mortality at 2 years ( 7.0 % vs 9.8 % , P = .13 ) . Patients in the endovascular repair group had reduced median procedure time ( 2.9 vs 3.7 hours ) , blood loss ( 200 vs 1000 mL ) , transfusion requirement ( 0 vs 1.0 units ) , duration of mechanical ventilation ( 3.6 vs 5.0 hours ) , hospital stay ( 3 vs 7 days ) , and intensive care unit stay ( 1 vs 4 days ) , but required substantial exposure to fluoroscopy and contrast . There were no differences between the 2 groups in major morbidity , procedure failure , secondary therapeutic procedures , aneurysm-related hospitalizations , health-related quality of life , or erectile function . CONCLUSIONS In this report of short-term outcomes after elective AAA repair , perioperative mortality was low for both procedures and lower for endovascular than open repair . The early advantage of endovascular repair was not offset by increased morbidity or mortality in the first 2 years after repair . Longer-term outcome data are needed to fully assess the relative merits of the 2 procedures . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00094575 The prevalence of abdominal aortic aneurysm ( AAA ) in a community‐based sample of men and women aged 65–79 years was correlated with known risk factors . In addition , the effect of high blood pressure and the use of antihypertensive medication on growth of AAAs were studied OBJECTIVES The endovascular aneurysm repair ( EVAR ) trials aim to assess the efficacy of EVAR in the treatment of AAA in terms of mortality , quality of life , durability and cost-effectiveness . DESIGN Male and female patients aged at least 60 years with an AAA diameter measuring at least 5.5 cm on a computed tomography ( CT ) scan are assessed for anatomical suitability for EVAR .  Suitable patients are offered entry either into EVAR Trial 1 if they are considered fit for conventional open repair or EVAR Trial 2 if they are considered unfit . EVAR 1 r and omly allocates patients to EVAR or open repair and EVAR 2 r and omly allocates patients to EVAR with best medical treatment or best medical treatment alone . Target recruitment for EVAR Trials 1 and 2 is 900 and 280 patients , respectively . PROGRESS Recruitment began in September 1999 and there are currently 40 UK centres participating in the trials . Monthly targets are being exceeded in EVAR Trial 1 with 1037 patients r and omised by October 2003 . EVAR Trial 2 is also meeting monthly targets with a total of 319 patients r and omised . When recruitment closes in December 2003 patients will need to be followed for at least 1 year from their operation . Publication of full results for both trials is expected in mid 2005 
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However , this advantage does not appear to be maintained in the long term .