title: Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995-2008: a retrospective observational study.
abstract: 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.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mscherm@bidmc.harvard.edu
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: Rodney P
authors.initials: RP
authors.lastname: Bensley
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Giles
authors.forename: Rob
authors.initials: R
authors.lastname: Hurks
authors.forename: A James
authors.initials: AJ
authors.lastname: Oʼmalley
authors.forename: Philip
authors.initials: P
authors.lastname: Cotterill
authors.forename: Elliot
authors.initials: E
authors.lastname: Chaikof
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D058017:Vascular Grafting / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data