Study finds endovascular aneurysm repair reduces ruptures, mortality

Minimally invasive elective repairs of abdominal aortic aneurysms, potential deadly bulges in arteries, reduces vessel rupture and short-term, AAA-related mortality, according to a Beth Israel Deaconess Medical Center study.
Endovascular abdominal aortic repair (EVAR), where surgeons use stents to repair damaged blood vessels, was first introduced in 1999 and has resulted in lower rates of death and complications than open surgical repair. It has allowed surgeons to offer the elective procedure for patients considered at too much risk for the traditional open repair and, when combined with increased detection, may be responsible for the increased numbers for repairs before the vessel ruptures.
Surgeons have been concerned, however, that EVAR may not be as effective in preventing late ruptures leading to potentially increased mortality after repair.
In a retrospective observational study of 338,278 Medicare patients undergoing intact repair between 1995 and 2008, BIDMC researchers found a decline in ruptures, with or without repair in all age groups, with a decline in operative mortality in both elective and emergent repairs.
‘The introduction of EVAR, combined with advanced abdominal imaging, may be responsible for an increasing number of intact AAA repairs in the United States, which should ultimately result in lower mortality from AAA rupture,’ says lead author Marc L. Schermerhorn, MD, Chief of the Division of Vascular and Endovascular Surgery within the Roberta and Stephen R. Weiner Department of Surgery at BIDMC and an Associate Professor of Medicine at Harvard Medical School.
The study found the overall rate of intact repair, adjusted for age and gender, increased from 79.9 to 85.0 per 100,000 Medicare beneficiaries during the study period. The rate decreased for those age 65-74, but increased in all other age groups, particularly for those age 80 and above.
The proportion of intact repairs using EVAR increased steadily over time, reaching 77 percent in 2008 for all age groups and 83 percent for patients over the age of 80.
Operative mortality with intact repair declined over time after the introduction of EVAR, with the greatest reduction for patients 80 and older. The overall rate of short-term AAA-related deaths for patients presenting at a hospital declined from 26.1 to 12.1 per 100,000 Medicare beneficiaries, mostly due to a 50 percent decline in the rate of ruptures and resulting deaths.
Schermerhorn noted several key findings, including a dramatic increase in intact AAA repairs in patients over 80