Endovascular aneurysm repair tied with long-term rupture and intervention: JAMA

Endovascular aneurysm repair is associated with a significant reduction in perioperative mortality and morbidity compared with open aneurysm repair in treating an abdominal aortic aneurysm. However, this benefit decreases over time owing to increased reinterventions and late aneurysm rupture after endovascular repair.

A study was conducted to compare long-term outcomes of endovascular vs open repair of abdominal aortic aneurysm.

This multicenter retrospective cohort study used de-identified data with a 6-year follow-up from the Medicare-matched Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database. Patients undergoing first-time elective endovascular or open abdominal aortic aneurysm repair from 2003 to 2018 were propensity score-matched. Patients with ruptured abdominal aortic aneurysm, concomitant procedures, or prior history of abdominal aortic aneurysm repair, were excluded. Data were analyzed from January 1, 2003, to December 31, 2018.

First-time elective endovascular or open repair for abdominal aortic aneurysm. The primary long-term outcome of interest was 6-year all-cause mortality, rupture, and reintervention. Secondary outcomes included 30-day mortality and perioperative complications.

The results of the study are:

• Among a total of 32 760 patients who underwent surgical abdominal aortic aneurysm repair, 28 281 patients underwent endovascular repair, and 4479 patients underwent open repair.
• After propensity score matching, there were 2852 patients in each group.
• Open repair was associated with significantly lower 6-year mortality than endovascular repair, with increases in mortality starting from 1 to 2 years and 2 to 6 years.
• Open repair, compared with endovascular repair, also was associated with significantly lower rates of 6-year rupture (117 participants [5.8%] vs 149 participants [8.3%]; HR, 0.76; 95% CI, 0.60-0.97; P < .001) and reintervention (190 participants [11.6%] vs 267 participants [16.0%]; HR, 0.67; 95% CI, 0.55-0.80; P < .001).
• Open repair was associated with significantly higher odds of 30-day mortality (OR, 3.56; 95% CI, 2.41-5.26; P < .001) and complications.

Thus, these findings suggest that overall mortality after elective abdominal aortic aneurysm repair was higher with endovascular repair than open repair despite reduced 30-day mortality and perioperative morbidity after endovascular repair. Endovascular repair was also associated with significantly higher long-term rupture and reintervention rates. These findings emphasize the importance of careful patient selection and long-term follow-up surveillance for patients who undergo endovascular repair.

Reference:

Long-term Outcomes Associated With Open vs Endovascular Abdominal Aortic Aneurysm Repair in a Medicare-Matched Database by Kevin Yei, et al. published in the JAMA

doi:10.1001/jamanetworkopen.2022.12081

Keywords:

Long-term, Outcomes, Associated, Open, Endovascular, Abdominal, Aortic, Aneurysm, Repair, Medicare, Matched, Database, Kevin Yei, JAMA, Asma Mathlouthi, Isaac Naazie, Nadin Elsayed, Bryan Clary, Mahmoud Malas,