Long-term Mortality and Reintervention after Endovascular and Open Abdominal Aortic Aneurysm Repairs in Australia, Germany, and the US.
Academic Article
Overview
abstract
OBJECTIVE: To examine long-term outcomes after endovascular (EVAR) and open repairs (OAR) for intact abdominal aortic aneurysms (AAA) in Australia, Germany, and the US, using a unified study design. SUMMARY BACKGROUND DATA: Similarities and differences in long-term outcomes after EVAR versus OAR across countries remain unclear, given differences in designs across existing studies. METHODS: We identified patients aged>65 years undergoing intact AAA repairs during 2010-2017/18. We compared long-term patient mortality and reintervention after EVAR and OAR using Kaplan-Meier analyses and Cox regressions. Propensity score matching was performed within each country to adjust for differences in baseline patient characteristics between procedure groups. RESULTS: We included 3311, 4909, and 145363 patients from Australia, Germany, and the US, respectively. The median patient age was 76-77 years, and most patients were male(77-84%). Patient mortality was lower after EVAR than OAR within the first 60 days and became similar at three-year follow-up (Australia 14.7% vs. 16.5%, Germany 18.2% vs. 19.7%, US: 24.4% vs. 24.4%). At the end of follow-up, patient mortality after EVAR was higher than OAR in Australia (HR[95%CI]=1.21[0.96-1.54]) but similar to OAR in Germany (HR[95%CI]=0.92[0.80-1.07]) and the US (HR[95%CI]=1.02[0.99-1.05]). The risk of reintervention after EVAR was more than twice that after OAR in Australia (HR[95%CI]=2.60[1.09-6.15]), Germany (HR[95%CI]=4.79[2.56-8.98]), and the US (HR[95%CI]=2.67[2.38-3.00]). The difference in reintervention risk appeared early in German and US patients. CONCLUSIONS: This multinational study demonstrated important similarities in long-term outcomes following EVAR versus OAR across three countries. Variation in long-term mortality and reintervention comparisons indicates possible differences in patient profiles, surveillance, and best medical therapy across countries.
