Large-Scale Analysis Compares EVAR Versus Open Repair in Germany


December 13, 2017—Findings from an analysis of short- and long-term results for endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) of abdominal aortic aneurysms (AAAs) in Germany were published by Christian-Alexander Behrendt, MD, et al in Journal of Vascular Surgery (JVS; 2017;66:1704–1711). The investigators noted that the background of the study is that although EVAR has emerged as a standard of care for AAA repair, real-world evidence to compare this technology to OAR is limited, with major gaps related to long-term outcomes of therapies worldwide.

As summarized in JVS, the investigators used health insurance claims data from Germany's third largest insurance provider, DAK-Gesundheit, to determine outcomes after interventions for intact AAA (iAAA) and ruptured AAA (rAAA) in patients treated between October 2008 and April 2015. The study was composed of 5,509 patients (3,627 EVAR and 1,859 OAR). Median follow-up was 2.44 years (range, 0–6.46 years).

The investigators reported in JVS that in-hospital mortality was lower after EVAR compared with OAR for both iAAA (1.2% vs 5.4%) and rAAA (26.1% vs 42%; P < .001). Postoperative length of stay and occurrence of complications were also lower after EVAR.

Additionally, the study showed that the in-hospital mortality benefits of EVAR were most prominent in octogenarians (EVAR, 2.2%; OAR, 18.2% for iAAA; EVAR, 34.4%; OAR, 62.3% for rAAA; P < .001). However, the early survival benefit after EVAR reversed at approximately 1.5 years, and Cox proportional hazard models revealed no differences in overall survival between EVAR and OAR. The investigators noted that landmark analysis focusing on patients surviving the procedure has shown lower survival in patients undergoing EVAR.

The investigators concluded, in the largest European investigation to date using health insurance claims data, that in-hospital outcomes in Germany favor EVAR, which is comparable to findings reported in the United States and the United Kingdom. Trends toward lower long-term survival after EVAR after discharge are important and require future research and reflection, noted the investigators in JVS.


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