Key result
Endovascular aortic repair was associated with higher all-cause mortality compared to open aneurysm repair (6.4% vs 4.6%; adjHR 1.34, 95% CI 1.07-1.67, P=0.010).
Why the study?
Does endovascular aortic repair improve survival compared to open aneurysm repair in patients with non-ruptured abdominal aortic aneurysm?
Cohort (n=7,805)
Yes
Does endovascular aortic repair improve survival compared to open aneurysm repair in patients with non-ruptured abdominal aortic aneurysm?
In patients with non-ruptured abdominal aortic aneurysm, endovascular repair was associated with higher long-term all-cause mortality and more frequent readmissions compared to open repair.
Should not yet change practice favoring endovascular repair; leaves open whether selection bias explains higher mortality in this cohort.
OBJECTIVES: The aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR). DESIGN: Retrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer. MATERIALS: In the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016. The data on mortality, selected concomitant diseases and readmissions were collected. A total of 7805 patients (mean age 70.9±8.1 yrs, 85.8% males) underwent OAR (n = 2336) or EVAR (n = 5469). A median follow up was 27.5 months (IQR range 10.0-38.4 months). METHODS: The primary outcome variable was all-cause mortality, secondary outcomes included 30-day mortality and readmissions. Kaplan-Meier (K-M), Cox proportional-hazards and propensity score analyses were performed for primary and secondary outcomes adjusting for repair type of AAA (OAR vs. EVAR), age, sex and concomitant diseases. RESULTS: EVAR patients had higher all-cause mortality (6.4% vs. 4.6% P = 0.002, adjHR 1.34, 95%CI 1.07-1.67, P = 0.010) compared with OAR. The mortality risks for OAR patients decreased below those for EVAR patients after 9.9 months. Of all the tested confounding factors only age independently and significantly influenced long-term mortality. Readmissions occurred more often in EVAR than in OAR (16.5% vs. 8.4% P<0.001, adjHR 2.15, 95%CI 1.84-2.52, P<0.001) independently from other covariants. Survival and readmissions Kaplan-Meier curves remained statistically different between OAR and EVAR patients after propensity score matching. CONCLUSIONS: Survival benefit of EVAR over OAR disappeared early during the first year after procedure, particularly in patients below 70 years of age, accompanied by an increased frequency of readmissions of EVAR patients. Our data suggest re-evaluation of the strategy for AAA management in vascular units in the country.
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Symonides et al. (2018) conducted a cohort in Non-ruptured abdominal aortic aneurysm (AAA) (n=7,805). Endovascular aortic repair (EVAR) vs. Open aneurysm repair (OAR) was evaluated on All-cause mortality (adjHR 1.34, 95% CI 1.07-1.67, p=0.010). Endovascular aortic repair was associated with higher all-cause mortality compared to open aneurysm repair (6.4% vs 4.6%; adjHR 1.34, 95% CI 1.07-1.67, P=0.010).
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