Total number of AAA repairs in US declining annually since 2005

The total number of abdominal aortic aneurysm repairs performed in the United States declined by 13% from 2003 to 2013, whereas the number of branched and fenestrated endovascular abdominal aortic aneurysm repairs has increased in recent years, according to data presented at the Society for Vascular Surgery 2016 Vascular Annual Meeting.

Mark F. Fillinger, MD, professor of surgery at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues analyzed national trends in open abdominal aortic aneurysm (AAA) repair, endovascular aortic repair, and branched and fenestrated endovascular aortic repair from 2003 to 2013 among Medicare beneficiaries.

“With the advent of branched-fenestrated aortic endografts, the number of [AAA] repairs could theoretically increase, due to patients [who] otherwise would not be offered open repair or infrarenal endovascular repair. However, it remains unclear how this novel approach is utilized in contemporary practice and how it may impact rates of open and standard endovascular repair,” Fillinger and colleagues wrote in an abstract.

The total number of AAA repairs declined from 27,352 in 2003 to 23,835 in 2013 (P = .01). A peak number of AAA repairs (n = 29,924) was performed in 2005, but numbers continued to decrease thereafter, according to the results.

The number of open AAA repairs overall decreased by 78%; the total number performed was 15,385 in 2003 compared with 3,315 in 2013 (P < .01).

The total number of endovascular aortic repairs rose from 11,967 in 2003 to 20,845 in 2008 (P = .1), but declined to 18,098 in 2013 (P = .09).

According to the researchers, no branched-fenestrated endovascular aortic repairs were performed in this population before 2011. Since 2011, the number of branched-fenestrated endovascular aortic repairs increased by more than 500%, from 401 in 2011 to 2,422 in 2013 (P < .01), according to the results.

In the most recent years studied (2011-2013), the number of open repairs decreased by 2,499 and the number of endovascular aortic repairs decreased by 2,415, according to the results.

“The continuous increase in [branched-fenestrated endovascular aortic repair] cases performed among Medicare patients over the last 3 years has not reversed the steady decline in overall numbers of AAA repairs, due to a concomitant decline in both open aneurysm repair and [endovascular aortic repair],” Fillinger and colleagues wrote.

These data highlight a potential shift in the type of AAA repair based on available technology and patient preference, according to the researchers. They noted that “future efforts are needed to determine the characteristics of patients treated with [branched-fenestrated endovascular aortic repair] as well as the long-term effectiveness of these new treatments.” – by Katie Kalvaitis

Reference:

Fillinger MF, et al. Plenary Session 4: S4. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.

Disclosure: Fillinger reports receiving consultant fees from Endologix and W.L. Gore.