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Decrease in Total Aneurysm Related Deaths (Intact and Ruptured) After Introduction of Endovascular Repair

Kristina Giles, Allen Hamdan, Frank Pomposelli, Ami Jhaveri, Marc Schermerhorn.
Beth Israel Deaconess Medical Center, Boston, Mass.

OBJECTIVES: To identify national trends in mortality after intact (iAAA) and ruptured abdominal aortic aneurysm (rAAA) repair encompassing the introduction of Endovascular AAA repair (EVAR). EVAR was FDA approved in 1999 and ICD-9 codes were available in 2000.

METHODS: Patients with iAAA or rAAA undergoing open or endovascular repair were identified within the 1988-2005 Nationwide Inpatient Sample database using ICD-9 diagnosis and procedure codes. This database represents a 20% random sample of national hospital admissions. The primary outcome was mortality after aneurysm repair for iAAA and rAAA.

RESULTS: From 1988 to 2005 the total number of aneurysm repairs increased from 6269 to 7593 [Table 1 and Figure 1]. The total number of iAAA repairs increased from 5136 to 6860 while the number of rAAA repairs decreased from 1133 to 733. During this time, overall annual deaths from aneurysm repairs decreased from 875 to 479 (iAAA 337 to 135; rAAA 538 to 298) [Table 1 and Figure 2]. Mortality for iAAA decreased from 6.6% to 2.6% while that for rAAA has also decreased (47.9% to 40.7%). Since 2000, endovascular repair has increased from 462 to 4109 and represents 58% of all iAAA in 2005. Mortality after both iAAA and rAAA was significantly lower in 2000-2005 than 1988-1999 (p<0.0001).

CONCLUSIONS: Over the past two decades the overall number of aneurysm repairs increased while the overall number of deaths decreased. This coincided with an increase in iAAA repair after the introduction of EVAR with lower elective mortality and a decrease in rAAA volume and deaths.

AUTHOR DISCLOSURES: K. Giles, None; A. Hamdan, None; F. Pomposelli, None; A. Jhaveri, None; M. Schermerhorn, None.