Endo Repair Shows Decrease in Total Aneurysm Deaths

Newswise — Using information from a nationwide database of hospital discharges from 1988-2005, researchers from Beth Israel Deaconess Medical Center in Boston report that in the U.S. population deaths from all abdominal aortic aneurysms (AAAs) as well as the total ruptured AAAs (rAAAs) is declining, while the number of elective repairs is increasing. The study will be presented during the Vascular Annual Meeting, June 5-8, in San Diego, Calif.

According to a presentation at the 62nd Annual Meeting of the Society for Vascular Surgery, these improved results coincide with the introduction of endovascular aneurysm repair (EVAR), approved by the Food and Drug Administration in 1999.

The study showed that during the last 17 years, the average number of elective repairs performed annually has increased from 34,147 to 35,744. Conversely, the overall annual number of ruptures of AAA decreased from 9,662 pre-EVAR to 7,017 post-EVAR, and rupture repairs decreased from 6,607 to 4,617.
Marc Schermerhorn, MD, assistant professor of surgery, Harvard Medical School and chief in the section of endovascular surgery at Beth Israel Deaconess, explained researchers calculated the deaths from elective repair, ruptured repair and ruptured aneurysms without repair. The overall annual number of aneurysm-related deaths was 6,741 pre-EVAR (1988-1999) and 4,640 post-EVAR (2000-2005). Mortality of patients during the “endovascular era” decreased from 5,309 in 2000 to 3,949 in 2005. The average death rate after rupture repair dropped from 45 percent pre-EVAR vs. 41 percent post-EVAR. The mortality rate in 2005 alone dropped 35 percent from endovascular repair and 41 percent from open repair.

Post-EVAR, the average number of annual deaths in each classification decreased as follows: elective AAA repair 1,598 vs. 1,136; ruptured AAA repair 2,978 vs. 1,875; and ruptured AAA without repair 2,238 vs. 1,629. Additionally, the overall mortality rate with elective repair has decreased after EVAR was introduced, from 4.7 percent to 3.2 percent, with an average mortality after endovascular repair of 1.4 percent.

“In the case of standard open surgical elective repair, mortality was 4.7 percent pre-EVAR and 4.5 percent post-EVAR,” said Dr. Schermerhorn.

Dr. Schermerhorn described that the database used in this study represented a 20 percent sample of national non-federal hospital admissions (with sample weights allowing extrapolation to 100 percent) and the decreased mortality rates support the benefit of endovascular repair rather than open surgery in suitable patients.

These findings will be presented at the Annual Meeting by Kristina Giles, MD, a general surgery resident at Beth Israel Deaconess Medical Center.

About the Society for Vascular Surgery
The Society for Vascular Surgery (SVS) is a not-for-profit society that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 2,400 vascular surgeons dedicated to the prevention and cure of vascular disease. Visit the website at http://www.VascularWeb.org.