title: Ten-year comparison of all-cause mortality after endovascular or open repair of abdominal aortic aneurysms: a propensity score analysis.
abstract: BACKGROUND
  This study aimed to compare the long-term survival after open (OS) or endovascular (EVAR) repair of abdominal aortic aneurysms (AAAs), exploring baseline factors that could affect long-term outcome.
  
  
  METHODS
  We identified 774 patients (501 EVAR, 273 OS, during 1996-2004) with data on perioperative risk factors including 37 variables assessed with a standardized patient response instrument. Propensity score was used to adjust for baseline differences between the two cohorts. Matched cohorts survival analysis and Cox multivariate regression were performed.
  
  
  RESULTS
  Median follow-up was 6.95 (interquartile range 4.46-9.27) years. EVAR patients were older [75.0 ± 7.7 (SD) vs. 71.3 ± 8.5 years, p < 0.001] and had a higher rate of previous myocardial infarction (39.3 vs. 25.3%, p < 0.001), pulmonary disease (25.9 vs. 18.3%, p = 0.020), and history of malignancy (5.0 vs. 1.8%, p = 0.039). The 30-day mortality was comparable (1.4% EVAR, 1.5% OS). Although the unadjusted survival rate was lower (median survival: 7.4 years EVAR, 8.8 OS, p = 0.011) and early (within 4 years) hazard was higher after EVAR (p = 0.003), no difference in survival was observed after propensity score-matching (p = 0.688) or propensity score-adjusted Cox regression (hazard ratio 1.01, 95 % confidence interval 0.82-1.25, p = 0.911, EVAR vs. OS). There was a trend toward higher hazard later in both groups. A multivariate Cox regression identified age, pulmonary disease, stroke, dialysis, oral anticoagulation, cardiac enlargement, and smoking history as variables associated with poor survival. Lipid-lowering medication was found to be protective.
  
  
  CONCLUSIONS
  Over long-term follow-up, survivals after endovascular and open repair of AAA are similar. Baseline patient characteristics are correlated with survival, but whether attention to the modifiable risk factor can alter outcome remains to be defined.
authors.affiliation: Department of Surgery, Hanyang University Guri Hospital, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-791, Korea. hglee@hanyang.ac.kr
authors.forename: Hong-Gi
authors.initials: HG
authors.lastname: Lee
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Clair
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ouriel
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000379:methods* / Q000401:mortality*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality