Long-term Mortality and Reintervention After Endovascular and Open Abdominal Aortic Aneurysm Repairs in Australia, Germany, and the United States

Abstract

Objective: To examine long-term outcomes after endovascular (EVAR) and open repairs (OAR) for intact abdominal aortic aneurysms in Australia, Germany, and the United States, using a unified study design. Background: Similarities and differences in long-term outcomes after EVAR versus OAR across countries remained unclear, given differences in designs across existing studies. Methods: We identified patients aged >65 years undergoing intact abdominal aortic aneurysm repairs during 2010-2017/2018. We compared long-term patient mortality and reintervention after EVAR and OAR using Kaplan-Meier analyses and Cox regressions. Propensity score matching was performed within each country to adjust for differences in baseline patient characteristics between procedure groups. Results: We included 3311, 4909, and 145363 patients from Australia, Germany, and the United States, respectively. The median patient age was 76 to 77 years, and most patients were males (77%–84%). Patient mortality was lower after EVAR than OAR within the first 60 days and became similar at 3-year follow-up (Australia 14.7% vs 16.5%, Germany 18.2% vs 19.7%, United States: 24.4% vs 24.4%). At the end of follow-up, patient mortality after EVAR was higher than OAR in Australia [ hazard ratio (HR) 95% CI: 1.21 (0.96-1.54)] but similar to OAR in Germany [HR 95% CI: 0.92 (0.80-1.07)] and the United States [HR 95% CI: 1.02 (0.99-1.05)]. The risk of reintervention after EVAR was more than twice that after OAR in Australia [HR 95% CI: 2.60 (1.09-6.15)], Germany [HR 95% CI: 4.79 (2.56-8.98)], and the United States [HR 95% CI: 2.67 (2.38-3.00)]. The difference in reintervention risk appeared early in German and United States patients. Conclusions: This multinational study demonstrated important similarities in long-term outcomes after EVAR versus OAR across 3 countries. Variation in long-term mortality and reintervention comparisons indicates possible differences in patient profiles, surveillance, and best medical therapy across countries.

Massive Calcified Abdominal Aortic Aneurysm Presenting as Low Back Pain

“…Open versus endovascular treatment has been the subject of debate and a large multinational study demonstrated important similarities in long-term outcomes after endovascular and open aortic repairs across three countries Australia, Germany, and the United States [ 14 ]. Another study showed that both surgeries had high mortality, and 68.0% in the endovascular-repair group and 70.0% in the open-repair group died (hazard ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.13).…”

Hospital Incidence, Treatment, and Outcome of 885 Patients with Thoracoabdominal Aortic Aneurysms Treated in Switzerland over 10 Years—A Secondary Analysis of Swiss DRG Data

“…A major disadvantage of endovascular therapy is the increased reintervention rate and long-term complications compared with OAR, which is not reflected by this data. This problem is not only known for endovascular therapy of TAAA but also for AAA and endovascular treatment of the aortic arch [ 21 , 22 ]. In the treatment of AAA, late complications after endovascular repair lead to better long-term survival for open surgery after an initial benefit of endovascular therapy [ 21 , 23 ].…”

“…This problem is not only known for endovascular therapy of TAAA but also for AAA and endovascular treatment of the aortic arch [ 21 , 22 ]. In the treatment of AAA, late complications after endovascular repair lead to better long-term survival for open surgery after an initial benefit of endovascular therapy [ 21 , 23 ].…”