Treatment Outcome Trends for Non-Ruptured Abdominal Aortic Aneurysms: A Nationwide Prospective Cohort Study

Abstract

WHAT THIS PAPER ADDSThis paper provides an overview of trends in peri-operative outcomes of patients who underwent standard endovascular aneurysm repair (EVAR) or open surgical repair (OSR) for an intact abdominal aortic aneurysm between 2014 and 2019 and who were registered in a mandatory nationwide registry. This study shows that all peri-operative outcomes (mortality, major complications, and textbook outcome) of EVAR and OSR for intact abdominal aortic aneurysms have improved since 2014, except for peri-operative mortality following EVAR which remained unchanged.Objective: The Dutch Surgical Aneurysm Audit (DSAA) initiative was established in 2013 to monitor and improve nationwide outcomes of aortic aneurysm surgery. The objective of this study was to examine whether outcomes of surgery for intact abdominal aortic aneurysms (iAAA) have improved over time. Methods: Patients who underwent primary repair of an iAAA by standard endovascular (EVAR) or open surgical repair (OSR) between 2014 and 2019 were selected from the DSAA for inclusion. The primary outcome was perioperative mortality trend per year, stratified by OSR and EVAR. Secondary outcomes were trends per year in major complications, textbook outcome (TbO), and characteristics of treated patients. The trends per year were evaluated and reported in odds ratios per year. Results: In this study, 11 624 patients (74.8%) underwent EVAR and 3 908 patients (25.2%) underwent OSR. For EVAR, after adjustment for confounding factors, there was no improvement in peri-operative mortality (aOR [adjusted odds ratio] 1.06, 95% CI 0.94 e 1.20), while major complications decreased

An Epidemiologic Study of the Incidence and Mortality of Abdominal Aortic Aneurysms in Koreans Aged ≥50 Years from 2009 to 2018 Based on a National Database

“…The decrease in AAA correlated with reductions in cardiovascular risk factors, due in part to smoking cessation and treatment with cardiovascular drugs [ 21 , 23 ]. The mortality rate associated with the elective treatment of non-ruptured AAA has decreased in recent years [ 24 ], due in part to improvements in the treatment or adoption of endovascular techniques [ 25 ]. Similarly, the present study found that outcomes improved with the treatment of non-ruptured AAA.…”

Identification of abdominal aortic aneurysm subtypes based on mechanosensitive genes

“…Small aneurysms are at a low risk of rupture, a priority recommendation for regular follow-up, but there are currently no drugs that are effective in limiting aneurysm enlargement and aneurysms >5.4 cm in diameter require elective repair [2][3][4]. A large prospective cohort study indicates that, for non-ruptured AAA patients, there has been little change in perioperative mortality rates in recent years for two surgical treatment modalities: open surgical repair (OSR) and endovascular aneurysm repair (EVAR), with rates of 4.6% and 1.3%, respectively [5].…”

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

“…Over the years, a variety of factors, such as age, female sex, more complex aneurysm anatomy and the presence of cardiac, pulmonary and renal comorbidities, have been linked to higher rates of postoperative adverse events following the conventional management of AAA [ 6 ]. On the other hand, increased experience and the evolution of dedicated perioperative quality-improvement programs have ensured a more favorable outcome, in terms of morbidity and mortality, in patients undergoing either EVAR or open aneurysm repair [ 7 ]. However, patients treated with the endovascular approach should be considered a priori as high risk and, as in open repair, a variety of factors including sex, age and comorbid status may be indicative of future outcomes [ 8 ].…”