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Outcomes Following Intact and Ruptured Aneurysm Repair across Nations: Analysis of International Registries Data from the VASCUNET Collaboration 2014 - 2019.

Pherwani, Arun D; Johal, Amundeep S; Cromwell, David A; Boyle, Jonathan R; Szeberin, Zoltan; Venermo, Maarit; Beiles, Barry; Khashram, Manar; Lattmann, Thomas; Altreuther, Martin E; Laxdal, Elin; Behrendt, Christian-Alexander; Mani, Kevin; Budtz-Lilly, Jacob

Authors

Arun D Pherwani

Amundeep S Johal

David A Cromwell

Jonathan R Boyle

Zoltan Szeberin

Maarit Venermo

Barry Beiles

Manar Khashram

Thomas Lattmann

Martin E Altreuther

Elin Laxdal

Christian-Alexander Behrendt

Kevin Mani

Jacob Budtz-Lilly



Abstract

Objective
To determine the peri-operative mortality rate for intact and ruptured abdominal aortic aneurysm (AAA) repair in 10 countries and to compare practice and ou
tcomes over a six year period by age, sex, and geographic location.

Methods
This VASCUNET study used prospectively collected data from vascular registries in 10 countries on primary repair of intact and ruptured AAAs undertaken between January 2014 and December 2019. The primary outcome was peri-operative death (30 day or in hospital). Logistic regression models were used to estimate the association between peri-operative death, patient characteristics, and type of procedure. Factors associated with the use of endovascular aortic aneurysm repair (EVAR) were also evaluated.

Results
The analysis included 50 642 intact and 9 453 ruptured AAA repairs. The proportion of EVARs for intact repairs increased from 63.4% in 2014 to 67.3% in 2016 before falling to 62.3% in 2019 (p < .001), but practice varied between countries. EVAR procedures were more common among older patients (p < .001) and men (p < .001). Overall peri-operative mortality after intact AAA repair was 1.4% (95% confidence interval [CI] 1.3 – 1.5%) and did not change over time. Mortality rates were stable within countries. Among ruptured AAA repairs, the proportion of EVARs increased from 23.7% in 2014 to 35.2% in 2019 (p < .001). The average aortic diameter was 7.8 cm for men and 7.0 cm for women (p < .001). The overall peri-operative mortality rate was 31.3% (95% CI 30.4 – 32.2%); the rates were 36.0% (95% CI 34.9 – 37.2%) for open repair and 19.7% (95% CI 18.2 – 21.3%) for EVAR. This difference and shift to EVAR reduced peri-operative mortality from 32.6% (in 2014) to 28.7% (in 2019).

Conclusion
The international practice of intact AAA repair was associated with low mortality rates in registry reported data. There remains variation in the use of EVAR for intact AAAs across countries. Overall peri-operative mortality remains high after ruptured AAA, but an increased use of EVAR has reduced rates over time.. [Abstract copyright: Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.]

Citation

Pherwani, A. D., Johal, A. S., Cromwell, D. A., Boyle, J. R., Szeberin, Z., Venermo, M., …Budtz-Lilly, J. (in press). Outcomes Following Intact and Ruptured Aneurysm Repair across Nations: Analysis of International Registries Data from the VASCUNET Collaboration 2014 - 2019. European Journal of Vascular and Endovascular Surgery, 68(2), 162-170. https://doi.org/10.1016/j.ejvs.2024.02.019

Journal Article Type Article
Acceptance Date Feb 14, 2024
Online Publication Date Feb 19, 2024
Deposit Date Mar 11, 2024
Journal European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Print ISSN 1078-5884
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 68
Issue 2
Pages 162-170
DOI https://doi.org/10.1016/j.ejvs.2024.02.019
Keywords Abdominal aortic aneurysm, Surgery, EVAR, Registry, VASCUNET, Mortality
Public URL https://keele-repository.worktribe.com/output/762941