Changes in Abdominal Aortic Aneurysm Rupture and Short-Term Mortality, 1995–2008

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 Prior 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 over 75% of elective AAA repairs. Methods We identified Medicare beneficiaries undergoing AAA repair and those hospitalized with a ruptured AAA during the period 1995–2008 and calculated standardized annual rates of AAA-related deaths due to either elective repair or rupture. Results 338,278 patients underwent intact AAA repair over the study period. There were 69,653 patients with AAA rupture of whom 47,524 underwent repair. Intact repair rates increased substantially in those over age 80 (57.7 to 92.3 per 100,000, P<0.001), but decreased in those aged 65–74 (81.8 to 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 over the study period for both intact (4.9% to 2.4%, P<0.001) and ruptured (44.1% to 36.3%, P<0.001) AAA repair. Short-term AAA-related deaths decreased by more than half (26.1 to 12.1 per 100,000, P<0.001) with the greatest decline occurring in those over age 80 (53.7 to 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 over age 80.

Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population

“…6 Since the introduction of EVAR, however, overall mortality for rAAA hospitalizations with or without treatment has decreased. 1 Over the same time period, the proportion of rAAA repairs performed by EVAR has increased, while the mortality for EVAR and open repair for rAAA has decreased. If improved mortality in EVAR patients was due to selection of healthier patients, then we would expect to see an increase in mortality for patients undergoing open repair as EVAR was adopted.…”

“…Despite better preventive practices and increasing rates of repair of intact abdominal aortic aneurysms (AAA) in older and higher risk populations 1 , ruptured abdominal aortic aneurysm (rAAA) continues to cause over 5,000 deaths annually in the United States. 2,3 Autopsy data demonstrate that 50–70% of patients with ruptured AAA do not survive to hospital presentation.…”

“…As of 2008, only 31% of rAAA repairs in the US were treated with EVAR while more than 85% of intact repairs were treated with EVAR. 1,12 …”

Percutaneous versus femoral cutdown access for endovascular aneurysm repair

“…1 Percutaneous access (pEVAR) further minimizes invasiveness compared to femoral cutdown access (cEVAR). A recently published American multicenter randomized trial with 151 patients in centers of excellence with one stent graft, reported high success rates in selected pEVAR patients when compared to cEVAR.…”

Association of the Affordable Care Act Medicaid Expansion With Access to and Quality of Care for Surgical Conditions

“…20 Vascular diseases, including aortic aneurysm and PAD, are increasingly prevalent in the U.S., and timely appropriate management has been shown to directly impact both mortality and major morbidity. 21,22 We limited our sample to patients whose age was between 19 and 64 years. should be concentrated among the latter group (Medicaid/uninsured).…”