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.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
pubmed:
8
2
2022
medline:
14
3
2023
entrez:
7
2
2022
Statut:
ppublish
Résumé
Compare long-term mortality, secondary intervention and secondary rupture following elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR). EVAR has surpassed OSR as the most common procedure used to repair abdominal aortic aneurysm (AAA), but evidence regarding long-term outcomes is inconclusive. 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. 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) = 0.22, 95% confidence interval (CI) 0.140.33], but higher between 1 and 4 years (HR = 1.29, 95% CI 1.12-1.48) and after 4years (HR = 1.41, 95% CI 1.23-1.63). Secondary intervention rates were higher over the first 30 days (HR = 2.26, 95% CI 1.11-4.59), but lower between 1 and 4years (HR = 0.59, 95% CI 0.48-0.74). Secondary aortic intervention rates were higher across the entire follow-up period (HR = 2.52, 95% CI 2.06-3.07). Secondary rupture rates did not differ significantly (HR = 1.06, 95% CI 0.73-1.55). All-cause mortality beyond 1 year remained significantly higher for EVAR after adjusting for any secondary interventions, or secendary rupture. 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.
Sections du résumé
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) = 0.22, 95% confidence interval (CI) 0.140.33], but higher between 1 and 4 years (HR = 1.29, 95% CI 1.12-1.48) and after 4years (HR = 1.41, 95% CI 1.23-1.63). Secondary intervention rates were higher over the first 30 days (HR = 2.26, 95% CI 1.11-4.59), but lower between 1 and 4years (HR = 0.59, 95% CI 0.48-0.74). Secondary aortic intervention rates were higher across the entire follow-up period (HR = 2.52, 95% CI 2.06-3.07). Secondary rupture rates did not differ significantly (HR = 1.06, 95% CI 0.73-1.55). All-cause mortality beyond 1 year remained significantly higher for EVAR after adjusting for any secondary interventions, or secendary 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.
Identifiants
pubmed: 35129507
doi: 10.1097/SLA.0000000000005259
pii: 00000658-202304000-00056
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e955-e962Subventions
Organisme : FDA HHS
ID : U01 FD006936
Pays : United States
Organisme : FDA HHS
ID : U01 FD005478
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest and Source of Funding: This study was partially supported by the US Food and Drug Administration (Grant number U01FD005478, PI, Sedrakyan), and a National Health and Medical Council (NHMRC) Project Grant (no: 1162833). The funders had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. M.O.F. is supported by a NHMRC Early Career Research Fellowship (no: 1139133). R.L.V. is a consultant to Abbott Vascular, Medtronic, Intervene, Surmodics, Intact Vascular, Boston Scientific and BD Bard receiving modest honoraria. The authors report no conflicts of interest.
Références
Volodos’ NL, Shekhanin VE, Karpovich IP, et al. Samofiksiruiushchi?sia sinteticheski? protez dlia éndoprotezirovaniia sosudov [A self-fixing synthetic blood vessel endoprosthesis]. Vestn Khir Im I I Grek. 1986;137:123–125. Russian.
Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–499.
Sawang M, Paravastu SCV, Liu Z, et al. The Relationship Between Aortic Aneurysm Surgery Volume and Peri-Operative Mortality in Australia. Eur J Vasc Endovasc Surg. 2019;57:510–519.
Al-Jubouri M, Comerota AJ, Thakur S, et al. Reintervention after EVAR and open surgical repair of AAA: a 15-year experience. Ann Surg. 2013;258:652–658.
Chuen J, Theivendran M. Abdominal aortic aneurysm: An update. Aust J Gen Pract. 2018;47:252–256.
Antoniou GA, Antoniou SA, Torella F. Editor's Choice - Endovascular vs. Open Repair for Abdominal Aortic Aneurysm: Systematic Review and Meta-analysis of Updated Peri-operative and Long Term Data of Randomised Controlled Trials. Eur J Vasc Endovasc Surg. 2020;59:385–397.
Salata K, Hussain MA, de Mestral C, et al. Comparison of Outcomes in Elective Endovascular Aortic Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms. JAMA Netw Open. 2019;2:e196578.
Huang Y, Gloviczki P, Oderich GS, et al. Outcome after open and endovascular repairs of abdominal aortic aneurysms in matched cohorts using propensity score modeling. J Vasc Surg. 2015;62:304–311.e2.
Bulder RMA, Bastiaannet E, Hamming JF, et al. Meta-analysis of long-term survival after elective endovascular or open repair of abdominal aortic aneurysm. Br J Surg. 2019;106:523–533.
Johal AS, Loftus IM, Boyle JR, et al. Long-term survival after endovascular and open repair of unruptured abdominal aortic aneurysm. Br J Surg. 2019;106:1784–1793.
Khashram M, Williman JA, Hider PN, Jones GT, Roake JA. Systematic Review and Meta-analysis of Factors Influencing Survival Following Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg. 2001;51:203–215.
Maier B, Wagner K, Behrens S, et al. Comparing routine administrative data with registry data for assessing quality of hospital care in patients with myocardial infarction using deterministic record linkage. BMC Health Serv Res. 2016;16:605.
Mao J, Etkin CD, Lewallen DG, et al. Creation and Validation of Linkage Between Orthopedic Registry and Administrative Data Using Indirect Identifiers. J Arthroplasty. 2019;34:1076–1081.
Columbo JA, Ramkumar N, Martinez-Camblor P, et al. Five-year reintervention after endovascular abdominal aortic aneurysm repair in the Vascular Quality Initiative. J Vasc Surg. 2020;71:799–805.
Sweeting MJ, Patel R, Powell JT, et al., EVAR Trial Investigators. Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial. Ann Surg. 2017;266:713–719.
Australian and New Zealand Society for Vascular Surgery. Australasian Vascular Audit [Internet.]. ANZSVS. [cited December 10, 2020]; Available from: https://www.anzsvs.org.au/audit/ .
NSW Center for Health Record Linkage. Data Dictionaries [Internet.]. CHeReL. 2020 [December 10, 2020]; Available from: https://www.cherel.or-g.au/data-dictionaries .
NSW Centre for Health Record Linkage. Quality Assurance [Internet.]. CHeReL. 2012 [cited December 10, 2020]; Available from: https://www.cherel.org.au/quality-assurance .
Bolch CA, Chu H, Jarosek S, et al. Inverse probability of treatment-weighted competing risks analysis: an application on long-term risk of urinary adverse events after prostate cancer treatments. BMC Med Res Methodol. 2017;17:93.
Austin C. Using the Standardized Difference to Compare the Prevalence of a Binary Variable Between Two Groups in Observational Research. Commun Stat Simul Comput. 2009;38:1228–1234.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.
Patel R, Sweeting MJ, Powell JT, et al., EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomized controlled trial. Lancet. 2016;388:2366–2374.
Kieffer WK, Sonnenberg S, Windhaber RA, et al. Complications and reintervention following elective open abdominal aortic aneurysm repair: a 10– year retrospective analysis. Ann R Coll Surg Engl. 2012;94:177–180.
van Schaik TG, Yeung KK, Verhagen HJ, et al., DREAM trial participants Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2017;66:1379–13893.
Lederle FA, Kyriakides TC, Stroupe KT, et al., OVER Veterans Affairs Cooperative Study Group Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2019;380:2126–2135.
Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69:1465–1508.
Hoel AW, Nolan BW, Goodney PP, et al., Vascular Study Group of New England Variation in smoking cessation after vascular operations. J Vasc Surg. 2013;57:1338–1344.
Morris CK, Froelicher VF. Cardiovascular benefits of physical activity. Herz 1991;16:222–236.
Beiles CB, Bourke BM. Validation of Australian data in the Australasian Vascular Audit. ANZ J Surg. 2014;84:624–627.
ANZSVS Audit Monitoring Committee. 2019 AVA Public Report [Internet.]. ANZSVS. 2020 [cited December 10, 2020]; Available from: https://www.anzsvs.org.au/wp-content/uploads/2020/05/AVA-Public-report-2019.pdf .