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Home > Vascular Annual Meeting > RR15. Age Related Trends in Abdominal Aortic Aneurysms...

RR15. Age Related Trends in Abdominal Aortic Aneurysms: Repairs, Rupture, and Death Rates in the United States Medicare Population

Kristina A. Giles1, A. James O'Malley2, Philip Cotterill3, Frank B. Pomposelli1, Bruce E. Landon2, Marc L. Schermerhorn1
1Beth Israel Deaconess Medical Center, Boston, MA; 2Harvard Medical School, Boston, MA; 3Centers for Medicare and Medicaid Services, Baltimore, MD

OBJECTIVES: Recently the UK and ADAM small AAA trials showed that repair could safely be deferred in small AAA. EVAR has allowed safer elective AAA repair. We evaluated total AAA related mortality over the time period inclusive of these landmark events.

METHODS: All U.S. Medicare beneficiaries undergoing AAA repair, intact (iAAA) or ruptured (rAAA), or hospitalized for rupture without repair from 1996-2006 were identified. Event rates per 100,000 beneficiaries were compared in the young (65-74) and elderly (≥75) between 1996 and 2006.

RESULTS: iAAA decreased in the young but increased in the elderly (Table 1). In 2006 more iAAA were EVAR in the elderly (71%) than young (64%). Despite the increased rate of repair in the elderly, the population death rate from iAAA decreased more in the elderly than the young. AAA ruptures and rupture deaths decreased in both groups but more so in the elderly. Overall AAA related deaths have decreased in all Medicare beneficiaries but more so in the elderly. Despite this, the AAA related death rate of those over 74 is still 3 times that of those 65-74.

CONCLUSIONS: AAA rupture is decreasing in the young despite the deferral of elective AAA repair suggesting a decreasing incidence of AAA. EVAR has lowered the operative risk of iAAA while repair has expanded in the elderly. EVAR has likely allowed treatment of patients previously considered unfit for OAR yet still at risk for rupture. Total AAA related deaths are decreasing likely due in part to expanded treatment in the elderly with lower operative mortality with EVAR as well as lower incidence of AAA.

AUTHOR DISCLOSURES: K.A. Giles, None; A. O'Malley, None; P. Cotterill, None; F.B. Pomposelli, None; B.E. Landon, Gore Unrestricted Educational Grant; M.L. Schermerhorn, Gore Unrestricted Educational Grant; Endologix DSMB Grant.

Table 1.

Table 2.