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. 2012 Oct;256(4):651-8.
doi: 10.1097/SLA.0b013e31826b4f91.

Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995-2008: a retrospective observational study

Marc L Schermerhorn  1 , Rodney P Bensley, Kristina A Giles, Rob Hurks, A James Oʼmalley, Philip Cotterill, Elliot Chaikof, Bruce E Landon
Affiliations

Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995-2008: a retrospective observational study

Marc L Schermerhorn et al. Ann Surg. 2012 Oct.

Abstract

Objective: To examine the modern epidemiology of abdominal aortic aneurysm (AAA) rupture and short-term AAA-related mortality after the introduction of endovascular aneurysm repair (EVAR).

Background: Previous epidemiologic studies have demonstrated stable rates of AAA repair, repair mortality, and AAA rupture. Recently, EVAR has been introduced as a less invasive treatment method, and its use has expanded to more than 75% of elective AAA repairs.

Methods: We identified Medicare beneficiaries undergoing AAA repair and those hospitalized with a ruptured AAA during the period 1995 to 2008 and calculated standardized annual rates of AAA-related deaths due to either elective repair or rupture.

Results: A total of 338,278 patients underwent intact AAA repair during the study period. There were 69,653 patients with AAA rupture, of whom 47,524 underwent repair. Intact repair rates increased substantially in those older than 80 years (57.7-92.3 per 100,000, P < 0.001) but decreased in those 65 to 74 years old (81.8-68.9, P < 0.001). A decline in ruptures with and without repair was seen in all age groups. By 2008, 77% of all intact repairs and 31% of all rupture repairs were performed with EVAR (P < 0.001). Operative mortality declined during the study period for both intact (4.9%-2.4%, P < 0.001) and ruptured (44.1%-36.3%, P < 0.001) AAA repair. Short-term AAA-related deaths decreased by more than half (26.1-12.1 per 100,000, P < 0.001), with the greatest decline occurring in those older than 80 years (53.7-27.3, P < 0.001).

Conclusions: A recent decline in AAA rupture and short-term AAA-related mortality is demonstrated and likely related in part to the introduction and expansion of EVAR. This is due to decreased deaths from ruptures (with and without repair) and decreased mortality with intact repairs, particularly in patients older than 80 years.

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Conflict of interest statement

Conflicts of Interest and Source of Funding: Marc L. Schermerhorn is on the Endologix Data Safety and Monitoring Board and is a Medtronic consultant. Bruce E. Landon has received a Gore Unrestricted Educational Grant. For the remaining authors none were declared.

Figures

Figure 1
Figure 1
Changes in intact AAA repair rates subsequent to 1995 by age and year (gender adjusted)
Figure 2
Figure 2
Operative mortality for EVAR, open repair, and total AAA repairs for US Medicare beneficiaries, 1995–2008 A) Intact AAA B) Ruptured AAA
Figure 2
Figure 2
Operative mortality for EVAR, open repair, and total AAA repairs for US Medicare beneficiaries, 1995–2008 A) Intact AAA B) Ruptured AAA
Figure 3
Figure 3
Short-term AAA related deaths per 100,000 US Medicare beneficiaries (age and gender adjusted), 1995–2008
Figure 4
Figure 4
Intact AAA repairs, rupture deaths (with and without repair), and intact repair deaths in patients aged 80 and older (gender adjusted, per 100,000 Medicare Beneficiaries), 1995–2008
See this image and copyright information in PMC

References

    1. Bengtsson H, Bergqvist D. Ruptured abdominal aortic aneurysm: a population-based study. J Vasc Surg. 1993;18:74–80. - PubMed
    1. Bengtsson H, Bergqvist D, Sternby NH. Increasing prevalence of abdominal aortic aneurysms. A necropsy study. Eur J Surg. 1992;158:19–23. - PubMed
    1. Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–8. - PubMed
    1. Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302:1535–42. - PubMed
    1. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607–18. - PubMed

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