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 PS26. Long-Term Outcome After Open (OR) and Endovascular Repairs (EVAR) of Abdominal Aortic Aneurysms (AAAs) in Matched Cohorts Using Propensity Score Modeling

​Ying Huang, Peter Gloviczki, Gustavo S. Oderich, Audra A. Duncan, Kalra Manju, Mark D. Fleming, William S. Harmsen, Catherine E. Dvorak, Thomas C. Bower
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.

OBJECTIVES: To compare long-term outcomes after OR versus EVAR of AAAs at a tertiary center.
 
METHODS: Clinical data of consecutive AAA patients treated electively between 2000-2011 were retrospectively reviewed. Primary endpoint was all-cause mortality, secondary endpoints were complications, reinterventions and ruptures. Propensity score-based matching included age, gender, year of intervention and comorbidities was performed to compare outcomes.
 
RESULTS: There were 1,350 matched cohorts (mean age 74±7 years). Thirty-day mortality was 1.3% after OR, 1% after EVAR (p=0.40). Early complications were lower after EVAR (13% vs. 25%, p<0.0001). Mean follow-up was 4.2 years (30 days-12.7 years). At 5 years, all-cause mortality was lower, freedom from reintervention higher after OR (23% vs. 32%, 87% vs. 74%); freedom from complications the same (66%). In multivariable analysis, SVS-comorbidity score and age were associated with all-cause mortality. Results were similar in 1,791 unmatched cohorts. There were 2 ruptures after OR, 8 after EVAR (p=0.02).
 
CONCLUSIONS: Both elective OR and EVAR have low early mortality, EVAR has fewer early complications. Advanced age and comorbidities predict high late mortality. This study failed to support long-term benefits of EVAR because the procedure was associated with increased rates of late all-cause mortality, reinterventions and small but definite risk of late rupture.
 
AUTHOR DISCLOSURES: T. C. Bower: Nothing to disclose; A. A. Duncan: Nothing to disclose; C. E. Dvorak: Nothing to disclose; M. D. Fleming: Nothing to disclose; P. Gloviczki: Nothing to disclose; W. S. Harmsen: Nothing to disclose; Y. Huang: Nothing to disclose; K. Manju: Nothing to disclose; G. S. Oderich: Gore, Consulting fees or other remuneration (payment); Cook Medical, Consulting fees or other remuneration (payment).

 
Matched (n=1350)
Unmatched (n=1791)
OR (n=675)
EVAR (n=675)
P
OR (n=898)
EVAR (n=893)
P
Male (%)
583(86)
580(86)
.81
749(83)
785(88)
.007
30-day mortality (%)
9(1.3)
7(1.0)
.40
11(1.2)
10(1.1)
.86
5-year all-cause mortality (%)
23
32
.0001
20
34
.0001
5-year rupture (%)
0
0.54
.002
0.23
0.53
.02
 
Posted April 2013 

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