NICE publish EVAR appraisal


The UK National Institute for Health and Clinical Excellence (NICE) published final guidance this February on the use of endovascular stent grafts for the treatment of infrarenal abdominal aortic aneurysms.

The guidance recommends:

• Endovascular stent grafts are recommended as a treatment option for patients with unruptured infrarenal abdominal aortic aneurysms, for whom surgical intervention (open surgical repair or endovascular aneurysm repair) is considered appropriate.

• The decision on whether endovascular aneurysm repair is preferred over open surgical repair should be made jointly by the patient and their clinician after assessment of a number of factors including:

1. Aneurysm size and structure/shape

2. Patient age, general life expectancy and fitness for open surgery

3. The short- and long-term benefits and risks of the procedures including aneurysm-related mortality and operative mortality

• Endovascular aneurysm repair should only be performed in specialist centres by clinical teams experienced in the management of abdominal aortic aneurysms

• Endovascular aortic stent grafts are not recommended for patients with ruptured aneurysms except in the context of research.

Dr Gillian Leng, NICE deputy chief executive, said: “The overall incidence of abdominal aortic aneurysms has increased in recent years and is likely to increase further with the ageing of the general population.

“The independent Committee carefully considered the evidence and concluded that, where appropriate, endovascular stent grafts offered a good use of NHS resources for unruptured infrarenal abdominal aortic aneurysms.”