Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years

P. K. Gupta, B. Ramanan, T. G. Lynch, H. Gupta, X. Fang, M. Balters, Jason M Johanning, G Matthew Longo, Jason N Mactaggart, Iraklis I Pipinos

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24 Citations (Scopus)

Abstract

Objectives: Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age. Design: A retrospective analysis of prospectively collected data. Materials and methods: Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed. Results: Of the 651 patients, 369 (56.7%) underwent EVAR and 282 (43.3%) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1% and 0.4%, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR). Conclusions: These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA.

Original languageEnglish (US)
Pages (from-to)506-512
Number of pages7
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume43
Issue number5
DOIs
StatePublished - May 1 2012

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Abdominal Aortic Aneurysm
Aneurysm
Survival
Mortality
Multivariate Analysis
Quality Improvement
Body Mass Index
Stroke
Databases
Hemorrhage
Morbidity

Keywords

  • Abdominal aortic aneurysm
  • EVAR
  • NSQIP
  • Open surgical repair
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years",
abstract = "Objectives: Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age. Design: A retrospective analysis of prospectively collected data. Materials and methods: Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed. Results: Of the 651 patients, 369 (56.7{\%}) underwent EVAR and 282 (43.3{\%}) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1{\%} and 0.4{\%}, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR). Conclusions: These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA.",
keywords = "Abdominal aortic aneurysm, EVAR, NSQIP, Open surgical repair, Survival",
author = "Gupta, {P. K.} and B. Ramanan and Lynch, {T. G.} and H. Gupta and X. Fang and M. Balters and Johanning, {Jason M} and Longo, {G Matthew} and Mactaggart, {Jason N} and Pipinos, {Iraklis I}",
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pages = "506--512",
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T1 - Endovascular repair of abdominal aortic aneurysm does not improve early survival versus open repair in patients younger than 60 years

AU - Gupta, P. K.

AU - Ramanan, B.

AU - Lynch, T. G.

AU - Gupta, H.

AU - Fang, X.

AU - Balters, M.

AU - Johanning, Jason M

AU - Longo, G Matthew

AU - Mactaggart, Jason N

AU - Pipinos, Iraklis I

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Objectives: Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age. Design: A retrospective analysis of prospectively collected data. Materials and methods: Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed. Results: Of the 651 patients, 369 (56.7%) underwent EVAR and 282 (43.3%) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1% and 0.4%, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR). Conclusions: These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA.

AB - Objectives: Multiple randomised trials have demonstrated lower perioperative mortality after endovascular aneurysm repair (EVAR) compared to open surgical repair for infrarenal abdominal aortic aneurysms (AAAs). However, in these trials the mortality advantage for EVAR is being lost within 2 years of repair and the patients evaluated are relatively older with no study specifically comparing EVAR and open repair for patients younger than 60 years of age. Design: A retrospective analysis of prospectively collected data. Materials and methods: Patients younger than 60 years of age who underwent EVAR and open surgical repair for elective infrarenal AAA were identified from the 2007-09 National Surgical Quality Improvement Program (NSQIP) - a prospective database maintained at 237 centres across the United States. Univariate and multivariate analyses were performed. Results: Of the 651 patients, 369 (56.7%) underwent EVAR and 282 (43.3%) underwent open repair. Thirty-day mortality for EVAR and open repair were 1.1% and 0.4%, respectively. This was not significantly different on univariate (P = 0.22) as well as multivariate (P = 0.69) analysis after controlling for other co-morbidities. On multivariate analysis, body mass index, history of stroke and bleeding disorder prior to surgery were associated with a higher 30-day mortality after AAA repair (combined open and EVAR). Conclusions: These contemporary results demonstrate that the 30-day mortality rate after open repair is similar to that after EVAR in patients younger than 60 years with infrarenal AAA.

KW - Abdominal aortic aneurysm

KW - EVAR

KW - NSQIP

KW - Open surgical repair

KW - Survival

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