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July 1, 2020

Study Shows 5-Year Survival of Ruptured AAA Treated With EVAR Improved From 2004 to 2018

July 1, 2020—Investigators from the Society for Vascular Surgery’s Vascular Quality Initiative registry reported findings on 5-year survival after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (AAA) over the past 14 years compared with open repair. The study was published by Rens R.B. Varkevisser, BS, et al in Journal of Vascular Surgery (JVS; 2020;72:105-113).

The investigators concluded in JVS, “The 5-year survival after EVAR for ruptured AAA has improved over time, whereas survival after open repair remained constant. Consequently, the relative survival benefit of EVAR over open repair has increased over time, which should encourage further adoption of EVAR for ruptured AAA.”

In the study, the investigators identified repairs for ruptured infrarenal AAA within the Vascular Quality Initiative registry between 2004 and 2018. They compared the 5-year survival of EVAR and open repair between the early (2004-2012) and late (2013-2018) cohorts. In addition, EVAR was compared with open repair in the early and late cohorts. The investigators used propensity score modeling to create matching cohorts for each analysis. Kaplan-Meier analysis was used to estimate survival proportions and univariate Cox proportional hazards analysis was used to compare differences in hazard of mortality in the matched cohorts.

As summarized in JVS, of the 4,638 ruptured AAA repairs identified, there were 409 EVARs in the early cohort and 2,250 EVARs in the late cohort. There were 558 open repairs in the early cohort and 1,421 in the late cohort.

Propensity matching resulted in 366 matched pairs of late versus early EVAR and 391 matched pairs of late versus early open repair. When comparing EVAR with open repair, propensity matching resulted in 277 matched pairs of early EVAR versus open and 1,177 matched pairs of late EVAR versus open.

The investigators found that in matched EVAR patients, 5-year survival was higher in the late cohort (63% vs 49%; hazard ratio [HR], 0.77; 95% CI, 0.61-0.97; P = .027), whereas there was no difference between matched late versus early for open repair patients (52% vs 59%; HR, 1.04; 95% CI, 0.85-1.28; P = .69).

In the early cohort, there was no survival difference between EVAR and open repair (51% vs 46%; HR, 0.88; 95% CI, 0.69-1.11; P = .28). However, in the late cohort, EVAR was associated with higher survival compared with open repair (63% vs 54%; HR, 0.69; 95% CI, 0.6-0.79; P < .001), reported the investigators in JVS.

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