Swedish Population-Based Study Compares EVAR and Open Repair for rAAA

August 6, 2015—Kim Gunnarsson, MD, et al published findings from a study that investigated the effect of primary repair strategy on early and midterm survival in the nonselected population-based Swedish Vascular Registry. The study is available online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES). In randomized trials, no perioperative survival benefit has previously been shown for endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) when compared with open repair. 

The investigators concluded that there was no difference in mortality after rAAA repair among centers with a primary EVAR approach when compared with a primary open-repair strategy, either perioperatively or in the midterm. The study supports the early findings of randomized controlled trials in a national population-based setting.

As summarized in EJVES, the investigators consulted the Swedish Vascular Registry to identify all rAAA repairs performed in Sweden from 2008 to 2012. Centers with a primary EVAR strategy (treating > 50% of rAAA with EVAR) were compared with centers with a primary open-repair strategy. Perioperative outcome, midterm survival, and incidence of rAAA repair/100,000 inhabitants aged > 50 years were assessed.

The investigators identified 1,304 rAAA patients who were treated at three primary EVAR centers (pEVARc; n = 236, 74.6% EVAR) and 26 primary open-repair centers (pORc; n = 1,068, 15.6% EVAR). Patients treated at pEVARc versus PORc were more often referrals (28% vs 5.3%), had a higher rate of respiratory comorbidity (36.5% vs 21.9%), and higher preoperative systolic blood pressure (84.3 mmHg vs 72.3 mmHg). 

There was no difference in mortality based on primary treatment strategy at 30 days (pEVARc 28%, n = 66; pORc 27.4%, n = 296), 1 year (pEVARc 39.9%, n = 93 vs pORc 34.7%, n = 366), or 2 years (pEVARc 42.1%, n = 94 vs 38.3%, n = 394), either overall or in subgroups based on age or referral status. Overall, patients treated with EVAR were older (mean age 76.4 vs 74 years), and had a lower 30-day mortality rate (EVAR 21.6%, n = 74; vs 29.6%, n = 288). Incidence of rAAA repair was lower in pEVARc regions versus pORc regions (6.07 vs 8.15), reported the investigators in EJVES.