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Erschienen in: CardioVascular and Interventional Radiology 2/2014

01.04.2014 | Clinical Investigation

Comparison of Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysm in the United States in the Past Decade

verfasst von: Prasoon P. Mohan, Michael H. Hamblin

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2014

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Abstract

Purpose

The purpose of this study is national-level comparison of the endovascular (EVAR) and open repair (OAR) of ruptured abdominal aortic aneurysm (AAA) in the United States from 2001 to 2010.

Methods

The data were obtained from nationwide inpatient sample from the Department of Health and Human Services. Ruptured AAA treated by OAR or EVAR were selected using combination ICD-9 codes.

Results

There were 42,126 cases of ruptured AAA of which 8,140 (19.3 %) were repaired by EVAR. EVAR patients were older (74.1 vs. 72.8 years, p < 0.001) and had higher incidence of comorbidities compared with OAR group. EVAR patients had lower in-hospital mortality (25.9 vs. 39.1 %, p < 0.001) and shorter hospital stay (10.4 vs. 13.7 days, p < 0.001). More patients were discharged home following EVAR (36.8 vs. 21.5 %, p < 0.001). There was reduced need for institutional rehabilitation following EVAR (26.3 vs. 29.1 %, p < 0.001). Females had significantly higher mortality compared with males after both EVAR (32.2 vs. 24.1 %, p < 0.001) and OAR (46.2 vs. 36.9 %, p < 0.001). The hospital mortality (41.3–25.8 %, p < 0.001) and mean length of stay (11.8–9.7 days, p < 0.01) of EVAR steadily improved over the study period.

Conclusions

National level comparison of data from the past decade shows that in suitable cases, EVAR for ruptured AAA is associated with reduced hospital mortality, shorter hospital stay, and reduced need for rehabilitation. EVAR outcomes showed consistent improvement with time. Regardless of the type of repair, women had higher mortality compared with men.
Literatur
1.
Zurück zum Zitat Albuquerque FC Jr, Tonnessen BH, Noll RE Jr, Cires G, Kim JK, Sternbergh WC 3rd (2010) Paradigm shifts in the treatment of abdominal aortic aneurysm: trends in 721 patients between 1996 and 2008. J Vasc Surg 51(6):1348–1352PubMedCrossRef Albuquerque FC Jr, Tonnessen BH, Noll RE Jr, Cires G, Kim JK, Sternbergh WC 3rd (2010) Paradigm shifts in the treatment of abdominal aortic aneurysm: trends in 721 patients between 1996 and 2008. J Vasc Surg 51(6):1348–1352PubMedCrossRef
2.
Zurück zum Zitat Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG (2004) EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848PubMedCrossRef Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG (2004) EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848PubMedCrossRef
3.
Zurück zum Zitat Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, Buskens E, Grobbee DE, Blankensteijn JD (2004) Dutch Randomized Endovascular Aneurysm Management (DREAM)Trial Group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618PubMedCrossRef Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, Buskens E, Grobbee DE, Blankensteijn JD (2004) Dutch Randomized Endovascular Aneurysm Management (DREAM)Trial Group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618PubMedCrossRef
4.
Zurück zum Zitat Yusuf SW, Whitaker SC, Chuter TA, Wenham PW, Hopkinson BR (1994) Emergency endovascular repair of leaking aortic aneurysm. Lancet 344(8937):1645PubMedCrossRef Yusuf SW, Whitaker SC, Chuter TA, Wenham PW, Hopkinson BR (1994) Emergency endovascular repair of leaking aortic aneurysm. Lancet 344(8937):1645PubMedCrossRef
5.
Zurück zum Zitat Peppelenbosch N, Yilmaz N, van Marrewijk C, Buth J, Cuypers P, Duijm L, Tielbeek A (2003) Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Outcome of a prospective intent-to-treat by EVAR protocol. Eur J Vasc Endovasc Surg 26(3):303–310PubMedCrossRef Peppelenbosch N, Yilmaz N, van Marrewijk C, Buth J, Cuypers P, Duijm L, Tielbeek A (2003) Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Outcome of a prospective intent-to-treat by EVAR protocol. Eur J Vasc Endovasc Surg 26(3):303–310PubMedCrossRef
6.
Zurück zum Zitat Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W (2007) Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. J Vasc Surg 45(3):443–450PubMedCrossRef Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W (2007) Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. J Vasc Surg 45(3):443–450PubMedCrossRef
7.
Zurück zum Zitat Verhoeven EL, Kapma MR, Groen H, Tielliu IF, Zeebregts CJ, Bekkema F, van den Dungen JJ (2008) Mortality of ruptured abdominal aortic aneurysm treated with open or endovascular repair. J Vasc Surg 48(6):1396–1400PubMedCrossRef Verhoeven EL, Kapma MR, Groen H, Tielliu IF, Zeebregts CJ, Bekkema F, van den Dungen JJ (2008) Mortality of ruptured abdominal aortic aneurysm treated with open or endovascular repair. J Vasc Surg 48(6):1396–1400PubMedCrossRef
8.
Zurück zum Zitat Coppi G, Silingardi R, Gennai S, Saitta G, Ciardullo AV (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44:1140–1147PubMedCrossRef Coppi G, Silingardi R, Gennai S, Saitta G, Ciardullo AV (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44:1140–1147PubMedCrossRef
9.
Zurück zum Zitat Steiner C, Elixhauser A, Schnaier J (2002) The healthcare cost and utilization project: an overview. Eff Clin Pract 5:143–151PubMed Steiner C, Elixhauser A, Schnaier J (2002) The healthcare cost and utilization project: an overview. Eff Clin Pract 5:143–151PubMed
11.
Zurück zum Zitat Cuypers PW, Gardien M, Buth J, Peels CH, Charbon JA, Hop WC (2001) Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair. Br J Surg 88:1059–1065PubMedCrossRef Cuypers PW, Gardien M, Buth J, Peels CH, Charbon JA, Hop WC (2001) Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair. Br J Surg 88:1059–1065PubMedCrossRef
12.
Zurück zum Zitat Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W (2007) Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. J Vasc Surg 45:443–450PubMedCrossRef Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W (2007) Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. J Vasc Surg 45:443–450PubMedCrossRef
13.
Zurück zum Zitat Verhoeven EL, Kapma MR, Groen H, Tielliu IF, Zeebregts CJ, Bekkema F, van den Dungen JJ (2008) Mortality of ruptured abdominal aortic aneurysm treated with open or endovascular repair. J Vasc Surg 48:1396–1400PubMedCrossRef Verhoeven EL, Kapma MR, Groen H, Tielliu IF, Zeebregts CJ, Bekkema F, van den Dungen JJ (2008) Mortality of ruptured abdominal aortic aneurysm treated with open or endovascular repair. J Vasc Surg 48:1396–1400PubMedCrossRef
14.
Zurück zum Zitat McPhee J, Eslami MH, Arous EJ, Messina LM, Schanzer A (2009) Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001–2006): a significant survival benefit over open repair is independently associated with increased institutional volume. J Vasc Surg 49(4):817–826PubMedCrossRef McPhee J, Eslami MH, Arous EJ, Messina LM, Schanzer A (2009) Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001–2006): a significant survival benefit over open repair is independently associated with increased institutional volume. J Vasc Surg 49(4):817–826PubMedCrossRef
15.
Zurück zum Zitat Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ (2008) Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective. J Vasc Surg 47(6):1165–1170PubMedCrossRef Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ (2008) Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective. J Vasc Surg 47(6):1165–1170PubMedCrossRef
16.
Zurück zum Zitat Hinchliffe RJ, Bruijstens L, MacSweeney ST, Braithwaite BD (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm: results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32(5):506–513PubMedCrossRef Hinchliffe RJ, Bruijstens L, MacSweeney ST, Braithwaite BD (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm: results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32(5):506–513PubMedCrossRef
17.
Zurück zum Zitat Peppelenbosch N, Geelkerken RH, Soong C, Cao P, Steinmetz OK, Teijink JA, Lepäntalo M, De Letter J, Vermassen FE, DeRose G, Buskens E, Buth J (2006) Endograft treatment of ruptured abdominal aortic aneurysms using the Talent Aortouniiliac system: an international multicenter study. J Vasc Surg 43(3):1111–1123PubMedCrossRef Peppelenbosch N, Geelkerken RH, Soong C, Cao P, Steinmetz OK, Teijink JA, Lepäntalo M, De Letter J, Vermassen FE, DeRose G, Buskens E, Buth J (2006) Endograft treatment of ruptured abdominal aortic aneurysms using the Talent Aortouniiliac system: an international multicenter study. J Vasc Surg 43(3):1111–1123PubMedCrossRef
18.
Zurück zum Zitat Coppi G, Silingardi R, Gennai S, Saitta G, Ciardullo AV (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44:1140–1147PubMedCrossRef Coppi G, Silingardi R, Gennai S, Saitta G, Ciardullo AV (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44:1140–1147PubMedCrossRef
19.
Zurück zum Zitat Lachat ML, Pfammatter T, Witzke HJ, Bettex D, Künzli A, Wolfensberger U, Turina MI (2002) Endovascular repair with bifurcated stent-grafts under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Vasc Endovasc Surg 23(6):528–536PubMedCrossRef Lachat ML, Pfammatter T, Witzke HJ, Bettex D, Künzli A, Wolfensberger U, Turina MI (2002) Endovascular repair with bifurcated stent-grafts under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Vasc Endovasc Surg 23(6):528–536PubMedCrossRef
20.
Zurück zum Zitat Veith FJ, Ohki T, Lipsitz EC, Suggs WD, Cynamon J (2003) Treatment of ruptured abdominal aneurysms with stent grafts: a new gold standard? Semin Vasc Surg 16(2):171–175PubMedCrossRef Veith FJ, Ohki T, Lipsitz EC, Suggs WD, Cynamon J (2003) Treatment of ruptured abdominal aneurysms with stent grafts: a new gold standard? Semin Vasc Surg 16(2):171–175PubMedCrossRef
21.
Zurück zum Zitat Gorham TJ, Taylor J, Raptis S (2004) Endovascular treatment of abdominal aortic aneurysm. Br J Surg 91:815–827PubMedCrossRef Gorham TJ, Taylor J, Raptis S (2004) Endovascular treatment of abdominal aortic aneurysm. Br J Surg 91:815–827PubMedCrossRef
22.
Zurück zum Zitat Mehta M, Taggert J, Darling RC 3rd, Chang BB, Kreienberg PB, Paty PS, Roddy SP, Sternbach Y, Ozsvath KJ, Shah DM (2006) Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 44(1):1–8PubMedCrossRef Mehta M, Taggert J, Darling RC 3rd, Chang BB, Kreienberg PB, Paty PS, Roddy SP, Sternbach Y, Ozsvath KJ, Shah DM (2006) Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 44(1):1–8PubMedCrossRef
23.
Zurück zum Zitat Veith FJ, Lachat M, Mayer D, Malina M, Holst J, Mehta M, Verhoeven EL, Larzon T, Gennai S, Coppi G, Lipsitz EC, Gargiulo NJ, van der Vliet JA, Blankensteijn J, Buth J, Lee WA, Biasi G, Deleo G, Kasirajan K, Moore R, Soong CV, Cayne NS, Farber MA, Raithel D, Greenberg RK, van Sambeek MR, Brunkwall JS, Rockman CB, Hinchliffe RJ (2009) RAAA investigators. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann Surg 250(5):818–824PubMedCrossRef Veith FJ, Lachat M, Mayer D, Malina M, Holst J, Mehta M, Verhoeven EL, Larzon T, Gennai S, Coppi G, Lipsitz EC, Gargiulo NJ, van der Vliet JA, Blankensteijn J, Buth J, Lee WA, Biasi G, Deleo G, Kasirajan K, Moore R, Soong CV, Cayne NS, Farber MA, Raithel D, Greenberg RK, van Sambeek MR, Brunkwall JS, Rockman CB, Hinchliffe RJ (2009) RAAA investigators. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann Surg 250(5):818–824PubMedCrossRef
24.
Zurück zum Zitat Sharif MA, Lee B, Makar RR, Loan W, Soong CV (2007) Role of the Hardman index in predicting mortality for open and endovascular repair of ruptured abdominal aortic aneurysm. J Endovasc Ther 14(4):528–535PubMedCrossRef Sharif MA, Lee B, Makar RR, Loan W, Soong CV (2007) Role of the Hardman index in predicting mortality for open and endovascular repair of ruptured abdominal aortic aneurysm. J Endovasc Ther 14(4):528–535PubMedCrossRef
25.
Zurück zum Zitat Anain PM, Anain JM Sr, Tiso M, Nader ND, Dosluoglu HH (2007) Early and mid-term results of ruptured abdominal aortic aneurysms in the endovascular era in a community hospital. J Vasc Surg 46(5):898–905PubMedCrossRef Anain PM, Anain JM Sr, Tiso M, Nader ND, Dosluoglu HH (2007) Early and mid-term results of ruptured abdominal aortic aneurysms in the endovascular era in a community hospital. J Vasc Surg 46(5):898–905PubMedCrossRef
26.
Zurück zum Zitat U.S. Preventive Services Task Force (2005) Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med 142(3):198–202CrossRef U.S. Preventive Services Task Force (2005) Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med 142(3):198–202CrossRef
27.
Zurück zum Zitat Mehta M, Byrne WJ, Robinson H, Roddy SP, Paty PS, Kreienberg PB, Feustel P, Darling RC 3rd (2012) Women derive less benefit from elective endovascular aneurysm repair than men. J Vasc Surg 55(4):906–913PubMedCrossRef Mehta M, Byrne WJ, Robinson H, Roddy SP, Paty PS, Kreienberg PB, Feustel P, Darling RC 3rd (2012) Women derive less benefit from elective endovascular aneurysm repair than men. J Vasc Surg 55(4):906–913PubMedCrossRef
28.
Zurück zum Zitat Abedi NN, Davenport DL, Xenos E, Sorial E, Minion DJ, Endean ED (2009) Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset. J Vasc Surg 50(3):486–491PubMedCrossRef Abedi NN, Davenport DL, Xenos E, Sorial E, Minion DJ, Endean ED (2009) Gender and 30-day outcome in patients undergoing endovascular aneurysm repair (EVAR): an analysis using the ACS NSQIP dataset. J Vasc Surg 50(3):486–491PubMedCrossRef
29.
Zurück zum Zitat Hertzer NR, O’Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG (1997) Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg 26:1–10PubMedCrossRef Hertzer NR, O’Hara PJ, Mascha EJ, Krajewski LP, Sullivan TM, Beven EG (1997) Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg 26:1–10PubMedCrossRef
30.
Zurück zum Zitat Enzler MA, Ruoss M, Seifert B, Berger M (1996) The influence of gender on the outcome of arterial procedures in the lower extremity. Eur J Vasc Endovasc Surg 11:446–452PubMedCrossRef Enzler MA, Ruoss M, Seifert B, Berger M (1996) The influence of gender on the outcome of arterial procedures in the lower extremity. Eur J Vasc Endovasc Surg 11:446–452PubMedCrossRef
31.
Zurück zum Zitat Franks SC, Sutton AJ, Bown MJ, Sayers RD (2007) Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 33:154–171PubMedCrossRef Franks SC, Sutton AJ, Bown MJ, Sayers RD (2007) Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 33:154–171PubMedCrossRef
32.
Zurück zum Zitat Ricotta JJ 2nd, Malgor RD, Oderich GS (2009) Endovascular abdominal aortic aneurysm repair: part I. Ann Vasc Surg 23:799–812PubMedCrossRef Ricotta JJ 2nd, Malgor RD, Oderich GS (2009) Endovascular abdominal aortic aneurysm repair: part I. Ann Vasc Surg 23:799–812PubMedCrossRef
33.
Zurück zum Zitat Mehta M, Kreienberg PB, Roddy SP, Paty PS, Taggert JB, Sternbach Y, Hnath J, Ozsvath KJ, Chang BB, Shah DM, Darling RC 3rd (2010) Ruptured abdominal aortic aneurysm: endovascular program development and results. Semin Vasc Surg 23(4):206–212PubMedCrossRef Mehta M, Kreienberg PB, Roddy SP, Paty PS, Taggert JB, Sternbach Y, Hnath J, Ozsvath KJ, Chang BB, Shah DM, Darling RC 3rd (2010) Ruptured abdominal aortic aneurysm: endovascular program development and results. Semin Vasc Surg 23(4):206–212PubMedCrossRef
Metadaten
Titel
Comparison of Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysm in the United States in the Past Decade
verfasst von
Prasoon P. Mohan
Michael H. Hamblin
Publikationsdatum
01.04.2014
Verlag
Springer US
Erschienen in
CardioVascular and Interventional Radiology / Ausgabe 2/2014
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-013-0665-4

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