Endovascular Repair Nudging Surgery for AAA

By Janice Rosenberg

CHICAGO -- Endovascular repair of aneurysms is replacing open surgery without an increase in overall case volume, according to the results of a study presented by Ellen D. Dillavou, M.D., at the Vascular Annual Meeting.

The study, "Improving Aneurysm-Related Outcomes: Nationwide Benefits of Endovascular Repair," looked at a random 5% sample of inpatient Medicare claims for 1994-2003 from the Centers for Medicare and Medicaid Services. The purpose of the study was to assess the effects of endovascular aneurysm repair (EVAR) on all patients with abdominal aortic aneurysm (AAA) repair, according to Dr. Dillavou of the University of Pittsburgh.

This minimally invasive procedure generally results in fewer deaths and shorter hospital stays than conventional open surgery for repairing AAAs.

EVAR has gained widespread acceptance in recent years. In 2000, only 5.8% of AAA repairs were done using EVAR. In 2003, more than 40% of aneurysm surgeries were performed using this method. During that time there was no overall increase in number of repairs.

The mean age of patients needing AAA repairs had not changed over those same years, but EVAR patients were found to be significantly older than patients treated with open repair. From 2000 to 2003, the percentage of patients aged 84 years or older who received EVAR increased from 10.4% to 62.7%.

If an AAA is detected before it ruptures, it can be repaired 95 percent of the time. Generally, repair is recommended when the aneurysm has a diameter of more than 2 inches. Less than 15 percent of patients with ruptured AAAs survive.

The researchers concluded that the use of EVAR is responsible for a significant reduction in the proportion of patients who die within the first 30 days after surgery. This reduction applied even to patients with ruptured AAAs, for whom repair is generally much riskier.

From 2000 to 2003, overall operative AAA mortality declined from 5.0% to 3.7%; mortality for open repair remained unchanged.

The study found that patients who received EVAR in 2003 left the hospital after an average of about 3.8 days, compared with 9.8 days for open surgery.

And an average of about 91% of the EVAR patients went home afterward, rather than to a skilled nursing facility. Of patients who were discharged from the hospital following open surgery, 75% went directly home.

"Our findings support the changing practice patterns for repair of abdominal aortic aneurysms," said Dr. Dillavou. "This minimally invasive procedure is setting a new standard for treating patients with this very serious condition, and is improving aneurysm surgery results across the country."

Coding for EVAR was approved in October 2000, leading to a widespread acceptance of the procedure and increased use in both academic and community hospital settings.