Objective: To examine the modern epidemiology of abdominal aortic aneurysm (AAA) rupture and short-term AAA-related mortality after the introduction of endovascular aneurysm repair (EVAR).
Background: Previous epidemiologic studies have demonstrated stable rates of AAA repair, repair mortality, and AAA rupture. Recently, EVAR has been introduced as a less invasive treatment method, and its use has expanded to more than 75% of elective AAA repairs.
Methods: We identified Medicare beneficiaries undergoing AAA repair and those hospitalized with a ruptured AAA during the period 1995 to 2008 and calculated standardized annual rates of AAA-related deaths due to either elective repair or rupture.
Results: A total of 338,278 patients underwent intact AAA repair during the study period. There were 69,653 patients with AAA rupture, of whom 47,524 underwent repair. Intact repair rates increased substantially in those older than 80 years (57.7–92.3 per 100,000, P < 0.001) but decreased in those 65 to 74 years old (81.8–68.9, P < 0.001). A decline in ruptures with and without repair was seen in all age groups. By 2008, 77% of all intact repairs and 31% of all rupture repairs were performed with EVAR (P < 0.001). Operative mortality declined during the study period for both intact (4.9%–2.4%, P < 0.001) and ruptured (44.1%–36.3%, P < 0.001) AAA repair. Short-term AAA-related deaths decreased by more than half (26.1–12.1 per 100,000, P < 0.001), with the greatest decline occurring in those older than 80 years (53.7–27.3, P < 0.001).
Conclusions: A recent decline in AAA rupture and short-term AAA-related mortality is demonstrated and likely related in part to the introduction and expansion of EVAR. This is due to decreased deaths from ruptures (with and without repair) and decreased mortality with intact repairs, particularly in patients older than 80 years.
We examine the modern epidemiology of abdominal aortic aneurysm (AAA) rupture and short-term AAA-related mortality after the introduction of endovascular aortic aneurysm repair in Medicare beneficiaries undergoing AAA repair and those hospitalized with a ruptured AAA during the period 1995 to 2008.
*Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
†Department of Health Care Policy, Harvard Medical School, Boston, MA
‡Centers for Medicare and Medicaid Services, Baltimore, MD
§Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Reprints: Marc L. Schermerhorn, MD, Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 5B, Boston, MA 02215. E-mail: firstname.lastname@example.org.
Supported by the NIH T32 Harvard-Longwood Research Training in Vascular Surgery grant HL007734, the NIH grant 1RC4MH092717-01 for comparative effectiveness research, and the NHLBI R01 grant HL105453.
Disclosure: The opinions expressed do not necessarily represent the views or policy positions of the Centers for Medicare and Medicaid Services. Marc L. Schermerhorn is on the Endologix Data Safety and Monitoring Board and is a Medtronic consultant. Bruce E. Landon has received a Gore Unrestricted Educational Grant. For the remaining authors no conflicts of interest were declared.
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