Survival After Endovascular vs Open Aortic Aneurysm Repairs.
OBJECTIVE
To our knowledge, long-term outcomes of open and endovascular (EVAR) repairs of abdominal aortic aneurysms (AAAs) have not been studied on a population level outside a controlled trial setting.


OBJECTIVE
To determine long-term outcomes of EVAR vs open repair on a population level.


METHODS
Analysis of the longitudinally linked California Office of Statewide Health Planning and Development inpatient database from 2001 to 2009. Median follow-up was 3.3 years.


METHODS
Endovascular vs open repairs.


METHODS
Mortality and complications at 30 days, as well as long-term mortality and complications up to 9 years.


RESULTS
In this observational study, a total of 23 670 patients were studied, with 52% receiving EVAR. Endovascular repair was associated with improved 30-day outcomes (all-cause mortality, readmission, surgical site infection, pneumonia, and sepsis), as well as significantly improved survival until 3 years postoperatively. After 3 years, mortality was higher for patients who underwent an EVAR repair. No significant difference in long-term mortality was observed for the entire cohort on adjusted analysis (hazard ratio, 0.99; 95% CI, 0.94-1.04; P = .64). Endovascular repair was found to be associated with a significantly higher rate of reinterventions and AAA late ruptures.


CONCLUSIONS
The survival advantage for EVAR repair in a statewide population is maintained for 3 years. After 3 years, EVAR repair was associated with higher mortality; however, these mortality differences did not reach statistical significance over the entire study period. Reintervention and late AAA rupture rates are higher after EVAR repair.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.
David C
DC
Chang
School of Medicine, University of California-San Diego.
Ralitza P
RP
Parina
Department of Surgery, University of California-Irvine, Orange.
Samuel E
SE
Wilson
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002140:California / Q000453:epidemiology; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology