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June 2, 2020

JVS Study Compares Long-Term Outcomes of EVAR and Open Repair to Treat rAAA

June 2, 2020—Findings from a population-based cohort study that sought to determine the long-term outcomes of endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for the treatment of ruptured abdominal aortic aneurysm (rAAA) were published by Konrad Salata, MD, et al in Journal of Vascular Surgery (JVS; 2020;71:1867-1878.e8). The JVS “Editor’s Choice” article is available for continuing medical education examination.

Using administrative data from Ontario, Canada, the investigators found lower hazards for all-cause mortality and major adverse cardiovascular events (MACE) within 30 days of procedures in favor of EVAR but no differences in the midterm or longer-term results. More work is needed to understand and improve the long-term outcomes of rAAA EVAR and OSR, advised the investigators.

According to the abstract in JVS, the study was composed of all patients aged ≥ 40 years who underwent OSR or EVAR of rAAA in Ontario, Canada, from 2003 to 2016. Administrative data from the province of Ontario were used as the data source.

For the study, the investigators performed the following:

  • Calculated the propensity for repair approach using a logistic regression model, including all covariates; the propensity for repair approach was used for inverse probability of treatment weighting.
  • Conducted Cox proportional hazards regression using the weighted cohort to determine the survival and MACE-free survival of EVAR relative to OSR for rAAA up to 10 years after repair.
  • Recorded a total of 2,692 rAAA repairs (261 EVAR [10%] and 2,431 OSR [90%]) from April 1, 2003, to March 31, 2016.

As reported in JVS:

  • The mean follow-up for the entire cohort was 3.4 years (standard deviation [SD], 3.9 years), with a maximum follow-up of 14 years.
  • OSR patients were followed for a mean of 3.5 years (SD, 4 years) and a maximum of 14 years.
  • EVAR patients were followed for a mean of 2.7 years (SD, 2.7 years) and a maximum of 11.4 years.
  • Median survival was 2.7 years overall, 2.5 years for OSR, and 3.7 years for EVAR patients.
  • There were no significant baseline differences between EVAR and OSR patients after inverse probability of treatment weighting.

The investigators found the following:

  • Within 30 days of repair, EVAR patients versus OSR patients were at lower hazard for all-cause mortality (hazard ratio, 0.49; 95% CI, 0.37-0.65; P < .01) and MACE (hazard ratio, 0.51; 95% CI, 0.4-0.66; P < .01).
  • From 30 days to 5 years, and from 5 to 10 years, there were no statistically significant differences between EVAR and OSR in the hazard for all-cause mortality or MACE.
  • The upfront mortality and MACE benefits of EVAR persisted for more than 4.5 years after repair.

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