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Home > Vascular Annual Meeting > PVSS3. Paradigm Shifts in the Treatment of AAA: Trends in 721 Patients Between 1996 -2008

PVSS3. Paradigm Shifts in the Treatment of AAA: Trends in 721 Patients Between 1996 -2008

Francisco C. Albuquerque, Jr, MD; Britt H. Tonnessen, MD; Robert E. Noll, MD; Jason K. Kim, MD; W. Charles Sternbergh, MD
Ochsner Clinic Foundation, New Orleans, LA

OBJECTIVES: Evaluation of the longitudinal trends in AAA management after availability of later-generation endografts.

METHODS: We retrospectively analyzed non-suprarenal AAA repairs between 1/1/96 – 12/31/08 at a single institution. Patients were stratified by treatment type (EVAR vs. open) and presence or absence of rupture. 30 days mortality rates were compared with Fisher’s exact test.

RESULTS: 721 patients underwent AAA repair over 12 years, 56.9% (n=410) with EVAR and 43.1% (n=311) open. A bimodal distribution of EVAR usage was observed (Figure 1), with initial escalation in the late 1990s. A nadir of EVAR usage occurred in the early 2000s, correlating with more conservative EVAR utilization after the limitations of first generation endografts were understood. EVAR utilization increased to an average of 84% between 2005-2008 as later generation endografts became available. The overall mortality rate for the entire cohort was 3.75%, 1.95% (8/410) for EVAR and 5.8% (19/311) for open repair (p=0.005). Ruptured AAA had a mortality rate of 0% for EVAR (n=0/8) vs. 31% for open (n=9/29), p=0.16. Non-ruptured AAA mortality was 1.99% (8/402) for EVAR vs. 4.8% (10/282) for open, p=0.23. A trend towards lower mortality was observed between 2003-2008 [1.0% (2/210), EVAR; 4.48% ( 3/67), open] when compared to 1996-2002 period [3.0% (6/200), EVAR; 6.56%(16/244), open].

CONCLUSIONS: AAA treatment has undergone a profound and sustained paradigm shift, now averaging over 80% of repairs performed with EVAR since 2004. Mortality was significantly less with EVAR compared to open repair, with both modalities becoming safer over the past 5 years.

AUTHOR DISCLOSURES: F.C. Albuquerque, None; B.H. Tonnessen, None; R.E. Noll, None; J.K. Kim, None; W.C. Sternbergh, Cook, Inc; W.L. Gore.

Figure 1.