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Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study.
Eur J Vasc Endovasc Surg. 2016 Jan; 51(1):22-8.EJ

Abstract

OBJECTIVE/BACKGROUND

In randomized trials, no peri-operative survival benefit has been shown for endovascular (EVAR) repair of ruptured abdominal aortic aneurysm (rAAA) when compared with open repair. The aim of this study was to investigate the effect of primary repair strategy on early and midterm survival in a non-selected population based study.

METHODS

The Swedish Vascular Registry was consulted to identify all rAAA repairs performed in Sweden in the period 2008-12. Centers with a primary EVAR strategy (treating > 50% of rAAA with EVAR) were compared with centers with a primary open repair strategy. Peri-operative outcome, midterm survival, and incidence of rAAA repair/100,000 inhabitants aged > 50 years were assessed.

RESULTS

In total, 1,304 patients were identified. Three primary EVAR centers (pEVARc) operated on 236 patients (74.6% EVAR). Twenty-six primary open repair centers (pORc) operated 1,068 patients (15.6% EVAR). Patients treated at pEVARc were more often referrals (28.0% vs. 5.3%; p < .01), had a higher rate of respiratory comorbidity (36.5% vs. 21.9%; p < .01), and higher pre-operative systolic blood pressure (84.3 vs. 72.3 mmHg; p < .01). There was no difference in mortality based on primary treatment strategy at 30 days (pEVARc 28.0%, n = 66; pORc 27.4%, n = 296 [p = .87]), 1 year (pEVARc 39.9%, n = 93; pORc 34.7%, n = 366 [p = .19]), or 2 years (42.1%, n = 94; 38.3%, n = 394 [p = .28]), either overall or in subgroups based on age or referral status. Overall, patients treated with EVAR were older (mean age 76.4 vs. 74.0 years; p < .01), and had a lower 30 day mortality (EVAR 21.6%, n = 74; odds ratio 29.6%, n = 288 [p = < .01]). Incidence of rAAA repair was lower in pEVARc regions (6.07, 95% confidence interval [CI] 5.01-7.13) when compared with pORc regions (8.15, 95% CI 7.64-8.66).

CONCLUSION

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 peri-operatively or in the midterm. The study supports the early findings of the randomized controlled trials in a national population based setting.

Authors+Show Affiliations

Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. Electronic address: kevin.mani@surgsci.uu.se.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26238308

Citation

Gunnarsson, K, et al. "Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: a National Population-based Study." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 51, no. 1, 2016, pp. 22-8.
Gunnarsson K, Wanhainen A, Djavani Gidlund K, et al. Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study. Eur J Vasc Endovasc Surg. 2016;51(1):22-8.
Gunnarsson, K., Wanhainen, A., Djavani Gidlund, K., Björck, M., & Mani, K. (2016). Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 51(1), 22-8. https://doi.org/10.1016/j.ejvs.2015.07.001
Gunnarsson K, et al. Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: a National Population-based Study. Eur J Vasc Endovasc Surg. 2016;51(1):22-8. PubMed PMID: 26238308.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National Population-based Study. AU - Gunnarsson,K, AU - Wanhainen,A, AU - Djavani Gidlund,K, AU - Björck,M, AU - Mani,K, Y1 - 2015/08/01/ PY - 2015/02/22/received PY - 2015/07/01/accepted PY - 2015/8/5/entrez PY - 2015/8/5/pubmed PY - 2016/5/3/medline KW - Abdominal aortic aneurysm KW - Endovascular repair KW - Rupture KW - Surgical outcome SP - 22 EP - 8 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 51 IS - 1 N2 - OBJECTIVE/BACKGROUND: In randomized trials, no peri-operative survival benefit has been shown for endovascular (EVAR) repair of ruptured abdominal aortic aneurysm (rAAA) when compared with open repair. The aim of this study was to investigate the effect of primary repair strategy on early and midterm survival in a non-selected population based study. METHODS: The Swedish Vascular Registry was consulted to identify all rAAA repairs performed in Sweden in the period 2008-12. Centers with a primary EVAR strategy (treating > 50% of rAAA with EVAR) were compared with centers with a primary open repair strategy. Peri-operative outcome, midterm survival, and incidence of rAAA repair/100,000 inhabitants aged > 50 years were assessed. RESULTS: In total, 1,304 patients were identified. Three primary EVAR centers (pEVARc) operated on 236 patients (74.6% EVAR). Twenty-six primary open repair centers (pORc) operated 1,068 patients (15.6% EVAR). Patients treated at pEVARc were more often referrals (28.0% vs. 5.3%; p < .01), had a higher rate of respiratory comorbidity (36.5% vs. 21.9%; p < .01), and higher pre-operative systolic blood pressure (84.3 vs. 72.3 mmHg; p < .01). There was no difference in mortality based on primary treatment strategy at 30 days (pEVARc 28.0%, n = 66; pORc 27.4%, n = 296 [p = .87]), 1 year (pEVARc 39.9%, n = 93; pORc 34.7%, n = 366 [p = .19]), or 2 years (42.1%, n = 94; 38.3%, n = 394 [p = .28]), either overall or in subgroups based on age or referral status. Overall, patients treated with EVAR were older (mean age 76.4 vs. 74.0 years; p < .01), and had a lower 30 day mortality (EVAR 21.6%, n = 74; odds ratio 29.6%, n = 288 [p = < .01]). Incidence of rAAA repair was lower in pEVARc regions (6.07, 95% confidence interval [CI] 5.01-7.13) when compared with pORc regions (8.15, 95% CI 7.64-8.66). CONCLUSION: 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 peri-operatively or in the midterm. The study supports the early findings of the randomized controlled trials in a national population based setting. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/26238308/Endovascular_Versus_Open_Repair_as_Primary_Strategy_for_Ruptured_Abdominal_Aortic_Aneurysm:_A_National_Population_based_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(15)00519-5 DB - PRIME DP - Unbound Medicine ER -