Despite more use of EVAR, mortality rates of ruptured AAA unchanged

The use of endovascular aneurysm repair has increased in those with ruptured abdominal aortic aneurysms in the past 10 years, but mortality rates have not changed, according to findings presented at the Society of Vascular Surgery 2016 Vascular Annual Meeting.

Researchers performed a retrospective review of 349 patients who underwent repair for a ruptured abdominal aortic aneurysm at the University of Pittsburgh Medical Center between 2003 and 2014. Among those patients, 73.6% underwent open repair and 26.4% underwent endovascular aneurysm repair (EVAR).

Patients were stratified by whether they had their repair from 2003 to 2008, when open surgery was predominant, or from 2009 to 2014, when EVAR was increasingly preferred.

Christopher B. Washington, MD, resident at University of Pittsburgh Medical Center, and colleagues compared the two groups in comorbidities, clinical presentation, operative technique, operator experience, postoperative complications and in-hospital mortality rates. They also identified independent predictors of in-hospital mortality.

Christopher B. Washington

The two groups were no different in age, sex or comorbidities.

The prevalence of EVAR increased from 11.2% in 2003-2008 to 40.8% in 2009-2016 (P < .001), Washington and colleagues found. The newer era also was associated with increases in paravisceral anatomy (10% vs. 17.3%; P = .047), use of balloon occlusion (0.6% vs. 6.6%; P = .011), percutaneous access (15.8% vs. 49.3%; P = .009) and procedures by operators with less than 5 years of experience (32% vs. 41%; P < .001), according to the researchers.

Compared with those who had a procedure in 2008 or before, those who had one in 2009 or later had less postoperative bowel resection (10.8% vs. 4.52%; P = .05), fewer respiratory complications (31.8% vs. 18.1%; P = .006) and a shorter length of stay (13 days vs. 7 days; P = .005).

However, Washington and colleagues reported that there was no difference between the groups in mortality rate (older era, 32.9%; newer era, 34.6%; P = .738).

After multivariable adjustment, the researchers identified the following independent predictors of mortality in the study population: cardiopulmonary resuscitation (OR = 5.2; P = .001), older age (OR = 1.05; P = .004), stage IV or V chronic kidney disease (OR = 2.65; P = .031) and open repair (OR = 0.431; P = .041).

“Factors that continue to predict mortality include hemodynamic instability, advanced comorbidities and anatomy requiring an open repair,” Washington and colleagues wrote in an abstract. “Increasing facility with endovascular repair, particularly with recent graduates, has reduced postoperative adverse events and length of stay; however, overall mortality rates have not improved.” – by Erik Swain

Reference:

Washington CB, et al. Plenary Session 4: SS21. Presented at: Society of Vascular Surgery 2016 Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.

Disclosure: Washington reports no relevant financial disclosures.