Survival After Endovascular vs Open Aortic Aneurysm Repairs

Area of Science:

• Vascular Surgery
• Health Services Research
• Public Health

Background:

• Long-term outcomes of abdominal aortic aneurysm (AAA) repair methods are crucial for clinical decision-making.
• Population-level data outside controlled trials are needed to understand real-world effectiveness.
• Open repair and endovascular aneurysm repair (EVAR) are primary treatment options for AAAs.

Purpose of the Study:

• To compare the long-term population-level outcomes of endovascular repair versus open repair for abdominal aortic aneurysms.
• To assess mortality and complication rates following EVAR and open AAA repair.

Main Methods:

• Analysis of a statewide inpatient database (California, 2001-2009) including 23,670 patients.
• Comparison of 30-day and long-term outcomes (up to 9 years) between EVAR and open repair groups.
• Statistical analysis including adjusted survival analysis.

Main Results:

• EVAR was associated with improved 30-day outcomes, including lower all-cause mortality, readmission, and infection rates.
• Survival advantage for EVAR was observed up to 3 years postoperatively.
• After 3 years, EVAR showed higher mortality, but overall long-term mortality did not significantly differ between groups.
• EVAR was linked to significantly higher rates of reintervention and late AAA rupture.

Conclusions:

• EVAR offers short-term benefits for AAA repair, with survival advantage maintained for 3 years.
• While EVAR shows higher late mortality, this did not reach statistical significance over the entire study period.
• Increased rates of reintervention and late AAA rupture necessitate careful consideration following EVAR.