Abdominal aortic aneurysm: An update

Chuen, Jason; Theivendran, Mayo

doi:10.31128/afp-09-17-4340

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…5,22,23 However, our finding of higher all-cause mortality for EVAR patients beyond 1 year contrasts with the existing literature; a systematic review, other propensity-matched studies and updated results from RCTs. 5,7,20,24,25 Our study was unable to determine why patients who underwent EVAR had higher mortality beyond 1 year. Despite rigorous risk adjustment for patient clinical characteristics, there may be further unmeasured factors, with several possible explanations.…”

Section: Discussioncontrasting

confidence: 97%

“…Our findings regarding higher perioperative mortality forOSR are consistent with published evidence. 5,22,23 However, our finding of higher all-cause mortality for EVAR patients beyond 1 year contrasts with the existing literature; a systematic review, other propensity-matched studies and updated results from RCTs. 5,7,20,24,25 Our study was unable to determine why patients who underwent EVAR had higher mortality beyond 1 year.…”

Section: Discussioncontrasting

confidence: 97%

“…4 However, it requires lifelong surveillance to monitor for graft migration and endoleak. 5 A recent systematic review and meta-analysis of randomized controlled trials (RCTs) demonstrated that EVAR has an early survival benefit compared to OSR, but mortality differences beyond 6 months were less certain 6 . Meta-analysis of three RCTs with long-term follow-up of 2484 patients found no difference in all-cause mortality; however, EVAR had an increased risk of aneurysm-related mortality beyond eight years.…”

mentioning

confidence: 99%

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Long-Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms

Garland

Falster

Beiles³

et al. 2021

Annals of Surgery

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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). Allcause 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.

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Section: Discussioncontrasting

confidence: 97%

Section: Discussioncontrasting

confidence: 97%

mentioning

confidence: 99%

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Long-Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms

Garland

Falster

Beiles³

et al. 2021

Annals of Surgery

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“…This is consistent with surgeons maintaining rigorous criteria when selecting patients to undergo AAA repair. 25 Similar transitions have been shown in inguinal hernia repair, with a shift from open to laparoscopic surgery, without an overall increase in the number of cases. 26…”

Section: Discussionmentioning

confidence: 54%

“…Abdominal aortic aneurysm is one of the hallmark pathologies of vascular surgery and an area of intense research interest. 25 The introduction of minimally invasive techniques has fundamentally changed the way surgeons approach AAA repair. This study highlights the swift transition from open to endovascular surgery in the Australia private sector over twenty years.…”

Section: Discussionmentioning

confidence: 99%

Open versus Endovascular Abdominal Aortic Aneurysm Repair in the Australian Private Sector Over Twenty Years

et al. 2021

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Purpose Over the past two decades, the proliferation of endovascular surgery has changed the approach to abdominal aortic aneurysm (AAA) repair. In Australia, close to two-thirds of surgical procedures are performed in the private healthcare system. We aimed to describe the trends in AAA repair in the Australian private sector throughout the early 21st century. Materials and Methods Medicare Benefits Schedule (MBS) statistics were accessed to determine the number of infrarenal open AAA repair (OAR) and endovascular AAA repair (EVAR) procedures performed between January 2000 and December 2019. Population data were extracted from the Australian Bureau of Statistics and used to calculate incidence per 100,000 population. Further analysis was performed according to age, gender, and state. Results During the study period, 13,193 (67.0%) EVARs and 6504 (33.0%) OARs were performed in the Australian private sector. OARs fell from 70.5% (n=567) of AAA repairs in 2000 to 15.7% (n=237) in 2019, while EVARs rose from 29.5% (n=151) to 84.3% (n=808). The frequency of EVAR surpassed OAR in 2004. The overall incidence of AAA repair varied minimally over the time period (range: 4.9–6.5 per 100,000 adults per year). AAA repair was more common in males than females (9.7 vs 1.7 per 100,000 population) and more common in older age groups. There was a 4-fold increase in EVAR among males older than 85 years (12.8–57.4 per 100,000 population), the largest rise of any group. The overall EVAR:OAR ratio increased from 0.4 to 5.4. There were considerable state-based discrepancies. Conclusion The landscape of AAA repair in Australian private sector has drastically changed with a clear preference toward EVAR. EVAR saw increased use across all genders, age groups and states, despite stable rates of AAA surgery. Further research is necessary to compare our findings to national trends in the Australian public sector.

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Effect of miR-126 on the Proliferation and Migration of Vascular Smooth Muscle Cells in Aortic Aneurysm Mice Under PI3K/AKT/mTOR Signaling Pathway

et al. 2021

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Abdominal aortic aneurysm: An update

Cited by 5 publications

References 22 publications

Long-Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms

Long-Term Outcomes Following Elective Repair of Intact Abdominal Aortic Aneurysms

Open versus Endovascular Abdominal Aortic Aneurysm Repair in the Australian Private Sector Over Twenty Years

Effect of miR-126 on the Proliferation and Migration of Vascular Smooth Muscle Cells in Aortic Aneurysm Mice Under PI3K/AKT/mTOR Signaling Pathway

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