Long Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms: A Comparison Between Open Surgical and Endovascular Repair Using Linked Administrative and Clinical Registry Data.
Academic Article
Overview
abstract
OBJECTIVE: Compare long-term mortality, secondary intervention and secondary rupture following elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR). BACKGROUND: EVAR has surpassed OSR as the most common procedure used to repair abdominal aortic aneurysm (AAA), but evidence regarding long-term outcomes is inconclusive. METHODS: We included patients in linked clinical registry and administrative data undergoing EVAR or OSR for intact AAA between January 2010 and June 2019. We used an inverse probability of treatment-weighted survival analysis to compare all-cause mortality, cause-specific mortality, secondary interventions and secondary rupture, and evaluate the impact of secondary interventions and secondary rupture on all-cause mortality. RESULTS: The study included 3460 EVAR and 427 OSR patients. Compared to OSR, the EVAR all-cause mortality rate was lower in the first 30 days (adjusted hazard ratio [HR]=0.24, 95% confidence interval (CI) 0.15-0.36), but higher between 1 and 4 years (HR=1.31, 95% CI 1.14-1.51) and after 4 years (HR=1.45, 95% CI 1.25-1.67). Secondary intervention rates were higher over the first 30 days (HR=2.20, 95% CI 1.09-4.44), but lower between 1 and 4 years (HR=0.60, 95% CI 0.49-0.75). Secondary aortic intervention rates were higher across the entire follow-up period (HR=2.45, 95% CI 2.01-2.99). Secondary rupture rates did not differ significantly (HR=1.15, 95% CI 0.78-1.70). All-cause mortality beyond 1 year remained significantly higher for EVAR after adjusting for any secondary interventions, or secondary rupture. CONCLUSIONS: EVAR has an early survival benefit compared to OSR. However, elevated long-term mortality and higher rates of secondary aortic interventions and subsequent aneurysm repair suggest that EVAR may be a less durable method of aortic aneurysm exclusion.
