Long-term Mortality and Reintervention After Endovascular and Open Abdominal Aortic Aneurysm Repairs in Australia, Germany, and the United States.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 09 2023
01 09 2023
Historique:
pmc-release:
01
09
2024
medline:
11
8
2023
pubmed:
21
12
2022
entrez:
20
12
2022
Statut:
ppublish
Résumé
To examine long-term outcomes after endovascular (EVAR) and open repairs (OAR) for intact abdominal aortic aneurysms in Australia, Germany, and the United States, using a unified study design. Similarities and differences in long-term outcomes after EVAR versus OAR across countries remained unclear, given differences in designs across existing studies. We identified patients aged >65 years undergoing intact abdominal aortic aneurysm repairs during 2010-2017/2018. We compared long-term patient mortality and reintervention after EVAR and OAR using Kaplan-Meier analyses and Cox regressions. Propensity score matching was performed within each country to adjust for differences in baseline patient characteristics between procedure groups. We included 3311, 4909, and 145363 patients from Australia, Germany, and the United States, respectively. The median patient age was 76 to 77 years, and most patients were males (77%-84%). Patient mortality was lower after EVAR than OAR within the first 60 days and became similar at 3-year follow-up (Australia 14.7% vs 16.5%, Germany 18.2% vs 19.7%, United States: 24.4% vs 24.4%). At the end of follow-up, patient mortality after EVAR was higher than OAR in Australia [ hazard ratio (HR) 95% CI: 1.21 (0.96-1.54)] but similar to OAR in Germany [HR 95% CI: 0.92 (0.80-1.07)] and the United States [HR 95% CI: 1.02 (0.99-1.05)]. The risk of reintervention after EVAR was more than twice that after OAR in Australia [HR 95% CI: 2.60 (1.09-6.15)], Germany [HR 95% CI: 4.79 (2.56-8.98)], and the United States [HR 95% CI: 2.67 (2.38-3.00)]. The difference in reintervention risk appeared early in German and United States patients. This multinational study demonstrated important similarities in long-term outcomes after EVAR versus OAR across 3 countries. Variation in long-term mortality and reintervention comparisons indicates possible differences in patient profiles, surveillance, and best medical therapy across countries.
Sections du résumé
OBJECTIVE
To examine long-term outcomes after endovascular (EVAR) and open repairs (OAR) for intact abdominal aortic aneurysms in Australia, Germany, and the United States, using a unified study design.
BACKGROUND
Similarities and differences in long-term outcomes after EVAR versus OAR across countries remained unclear, given differences in designs across existing studies.
METHODS
We identified patients aged >65 years undergoing intact abdominal aortic aneurysm repairs during 2010-2017/2018. We compared long-term patient mortality and reintervention after EVAR and OAR using Kaplan-Meier analyses and Cox regressions. Propensity score matching was performed within each country to adjust for differences in baseline patient characteristics between procedure groups.
RESULTS
We included 3311, 4909, and 145363 patients from Australia, Germany, and the United States, respectively. The median patient age was 76 to 77 years, and most patients were males (77%-84%). Patient mortality was lower after EVAR than OAR within the first 60 days and became similar at 3-year follow-up (Australia 14.7% vs 16.5%, Germany 18.2% vs 19.7%, United States: 24.4% vs 24.4%). At the end of follow-up, patient mortality after EVAR was higher than OAR in Australia [ hazard ratio (HR) 95% CI: 1.21 (0.96-1.54)] but similar to OAR in Germany [HR 95% CI: 0.92 (0.80-1.07)] and the United States [HR 95% CI: 1.02 (0.99-1.05)]. The risk of reintervention after EVAR was more than twice that after OAR in Australia [HR 95% CI: 2.60 (1.09-6.15)], Germany [HR 95% CI: 4.79 (2.56-8.98)], and the United States [HR 95% CI: 2.67 (2.38-3.00)]. The difference in reintervention risk appeared early in German and United States patients.
CONCLUSIONS
This multinational study demonstrated important similarities in long-term outcomes after EVAR versus OAR across 3 countries. Variation in long-term mortality and reintervention comparisons indicates possible differences in patient profiles, surveillance, and best medical therapy across countries.
Identifiants
pubmed: 36538620
doi: 10.1097/SLA.0000000000005768
pii: 00000658-202309000-00046
pmc: PMC10225011
mid: NIHMS1852287
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e626-e633Subventions
Organisme : NHLBI NIH HHS
ID : K01 HL159315
Pays : United States
Organisme : FDA HHS
ID : U01 FD006936
Pays : United States
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
A.W.B. received research support through the University of Alabama at Birmingham (UAB) from Cook Medical, Medtronic, Philips, Terumo Aortic, and W.L. Gore and Associates and participates in consulting activities (Artivion, Cook Medical, Medtronic, Philips, and Terumo Aortic) renumerated to UAB. R.L.V. is a consultant to Abbott Vascular, Philips, W.L. Gore, Medtronic, Boston Scientific, Intervene, Surmodics, BD Bard and Nectero. The remaining authors report no conflicts of interest.
Références
Svensjo S, Bjorck M, Gurtelschmid M, et al. Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease. Circulation. 2011;124:1118–1123.
Summers KL, Kerut EK, Sheahan CM, et al. Evaluating the prevalence of abdominal aortic aneurysms in the United States through a national screening database. J Vasc Surg. 2021;73:61–68.
Suckow BD, Goodney PP, Columbo JA, et al. National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients. J Vasc Surg. 2018;67:1690–1697. e1691.
Trenner M, Haller B, Storck M, et al. Trends in patient safety of intact abdominal aortic aneurysm repair: German Registry Data on 36,594 procedures. Eur J Vasc Endovasc Surg. 2017;53:641–647.
Mani K, Lees T, Beiles B, et al. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report. Eur J Vasc Endovasc Surg. 2011;42:598–607.
Beck AW, Sedrakyan A, Mao J, et al. Variations in abdominal aortic aneurysm care: a report from the international consortium of vascular registries. Circulation. 2016;134:1948–1958.
Greenhalgh RM, Brown LC, Kwong GP, et al. participants Et . Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843–848.
Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351:1607–1618.
Patel R, Sweeting MJ, Powell JT, et al. investigators Et . 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 randomised controlled trial. Lancet. 2016;388:2366–2374.
van Schaik TG, Yeung KK, Verhagen HJ, et al. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms. J Vasc Surg. 2017;66:1379–1389.
Lederle FA, Kyriakides TC, Stroupe KT, et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2019;380:2126–2135.
Schermerhorn ML, Buck DB, O'Malley AJ, et al. Long-term outcomes of abdominal aortic aneurysm in the medicare population. N Engl J Med. 2015;373:328–338.
Behrendt CA, Sedrakyan A, Riess HC, et al. Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany. J Vasc Surg. 2017;66:1704–1711. e1703.
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.
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.
Garland SK, Falster MO, Beiles CB, et al. 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. Ann Surg. 2021.
Karthikesalingam A, Holt PJ, Vidal-Diez A, et al. Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet. 2014;383:963–969.
Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.
Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147:W163–W194.
Beck AW, Goodney PP, Nolan BW, et al. Predicting 1-year mortality after elective abdominal aortic aneurysm repair. J Vasc Surg. 2009;49:838–843; discussion 843-834.
Behrendt CA, Kreutzburg T, Kuchenbecker J, et al. Female sex and outcomes after endovascular aneurysm repair for abdominal aortic aneurysm: a propensity score matched cohort analysis. J Clin Med. 2021;10:162.
Sedrakyan A, Goodney PP, Mao J, et al. Changes in the long-term risk of adverse outcomes in patients treated with open vs endovascular abdominal aortic aneurysm repair. JAMA Surg. 2022;157:733–735.
Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's choice-European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019;57:8–93.
Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67:2–77. e72.
de Guerre L, Dansey K, Li C, et al. Late outcomes after endovascular and open repair of large abdominal aortic aneurysms. J Vasc Surg. 2021;74:1152–1160.
Organisation for Economic Co-operation and Development. Life expectancy at birth. 2020. Accessed March 31, 2022. https://data.oecd.org/healthstat/life-expectancy-at-birth.htm
Greenblatt DY, Greenberg CC, Kind AJ, et al. Causes and implications of readmission after abdominal aortic aneurysm repair. Ann Surg. 2012;256:595–605.
Kociol RD, Lopes RD, Clare R, et al. International variation in and factors associated with hospital readmission after myocardial infarction. JAMA. 2012;307:66–74.
Goodney P, Mao J, Columbo J, et al. Use of linked registry claims data for long term surveillance of devices after endovascular abdominal aortic aneurysm repair: observational surveillance study. BMJ. 2022;379:e071452.
Falster MO, Garland SK, Jorm LR, et al. Comparison of outcomes for major contemporary endograft devices used for endovascular repair of intact abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2023;65:272–280.