Endovascular repair results in decrease of total aneurysm deaths

Elective repair for abdominal aortic aneurysms (AAA) is on the rise, yet total AAA- related deaths continue to decline since the introduction of endovascular repair (EVAR), according to an ongoing, long-term research report from Beth Israel Deaconess Medical Center in Boston.

This study has been updated with the most recent AAA data Nationwide Inpatient Sample database using ICD-9 diagnosis and procedure codes thorough 2005. It evaluates the overall annual number of aneurysm repairs, AAA-related deaths and mortality rates for both elective and rupture repair, rupture diagnoses without repair, and the effect of EVAR on the annual volume of aneurysm repair and its impact on rupture occurrence. Complete details of the research have been published in the March 2009 issue of the Journal of Vascular Surgery.

“We have found that use of EVAR, which was approved by the Food and Drug Administration in 1999, has increased steadily and in 2005 accounted for 56 percent of repairs, yet only 27 percent of the deaths for intact repairs,” said senior author Marc L. Schermerhorn, assistant professor of surgery, Harvard Medical School and section chief of endovascular surgery at the center's department of vascular surgery.

The overall number of AAA-related deaths (intact repair, ruptured repair, unrepaired ruptures) from 1993 to 2005 was 79,955 and the number of annual deaths decreased by 38 percent. The updated study showed that by 2005, the mean annual number of intact repairs increased from 36,122 in the pre-EVAR era (1993-1998) to 38,901 in the post-EVAR era (2001-2005). Despite the increase in repairs, the mean annual number of deaths related to intact AAA repair decreased from 1,693 pre-EVAR to 1,207 post-EVAR. Mortality for all intact AAA repair had decreased from 4.0 percent to 3.1 percent pre- and post-EVAR yet open repair mortality remained unchanged.

The overall mean annual number of ruptured AAA diagnoses dropped from 9,979 to 7,773 and overall mean annual deaths from a ruptured AAA decreased from 5,338 to 3,901 post-EVAR. From 1993 forward, admissions for ruptured AAA diagnosis decreased 30 percent and deaths after total repairs for ruptured AAA decreased from 2,702 in 1993 to 1,605 in 2005. Also in 2005, EVAR was performed in 17 percent of ruptured AAA repairs and mortality was decreased from 42.9 in 2001 to 30.3 percent in 2005.

Dr. Schermerhorn described that the database used in this study represented a 20 percent sample of national non-federal hospital admissions (with sample weights allowing extrapolation to 100 percent) and the decreased mortality rates support the benefit of endovascular repair rather than open surgery in suitable patients.