At present there is no evidence from clinical trials that the risk of rupture of an aneurysm is reduced following endovascular stent grafting. The risk of rupture is 1% per year, similar to the risk in patients who have not undergone surgery and are followed by ultrasonography. No large randomized clinical trial has convincingly documented that this repair technique confers a mortality benefit either preoperatively or long term compared to surgical repair. Most reports stem from single center, nonrandomized studies, but randomized trials comparing endovascular repair with surgery are now in progress. This technology requires further refinement to be generally acceptable. When the refinements are made, it will be useful in the elderly and in patients with comorbid conditions who are at high risk for surgery.

D. Clinical Studies
1. Lederle et al.
Study question: Does elective surgical repair of small abdominal aneurysms improve survival?
Methods: Patients 50–79 years old with abdominal aneurysms of 4–5.4 cm in diameter who did not have a high surgical risk (569 patients) underwent surveillance by means of ultrasonography or CT every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm (567 patients).

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