Abdominal aortic aneurysm: endovascular aortic repair not linked with long-term survival benefit

  • Salata K & al.
  • JAMA Netw Open
  • 3 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This study found no difference in long-term survival, reintervention or secondary rupture between patients who underwent endovascular aortic repair (EVAR) vs those who underwent open surgical repair (OSR) for abdominal aortic aneurysm (AAA) during >13 years of maximum follow-up.

Why this matters

  • There is limited literature regarding the long-term outcomes of EVAR with no population-based studies been conducted with >10 years of follow-up.

Study design

  • Retrospective, population-based cohort study of 17,683 patients (age, ≥40 years) who received elective AAA repairs during 2003-2016.
  • Outcome: Overall survival, major adverse cardiovascular event-free (MACE) survival.
  • Funding: Institute for Clinical Evaluative Sciences (ICES).

Key results

  • 6100 (34.5%) patients underwent EVAR and 11,583 (65.5%) underwent OSR.
  • EVAR vs OSR was associated with:
    • higher survival rates up to 1 year (94.0% [95% CI, 93.3-94.7%] vs 91.0% [95% CI, 90.1-91.9%]),
    • higher MACE-free survival rate for up to 4 years (72.9% [95% CI, 71.4-74.4%] vs 69.9% [95% CI, 68.3-71.3%]),
    • lower incidence of reintervention within 1 month (12.4% [95% CI, 11.4-13.5%] vs 15.0% [95% CI, 13.9-16.1%]),
    • higher incidence of reintervention after 7 years (45.9% [95% CI, 44.1-47.8%] vs 42.2% [95% CI, 40.4-44.0%]), and
    • long-term MACE-free survival (32.6% [95% CI, 26.9-38.4%] vs 14.1% [95% CI, 4.0-30.4%]; Pstratified log-rank=.0000001).
  • EVAR was significantly associated with:
    • higher all-cause mortality (HR, 1.16; 95% CI, 1.02-1.32; P=.02),
    • lower risk of MACE within 45 days (HR, 0.32; 95% CI, 0.27-0.39; P<.001>
    • lower reintervention within 1 month (HR, 0.74; 95% CI, 0.66-0.83; P<.001 and>
    • higher reintervention from 1-6 months and after 2 years (HR, 1.36; 95% CI, 1.12-1.65; P=.002 and HR, 1.11; 95% CI, 1.01-1.22; P=.03, respectively).

Limitations

  • Residual confounding.