Abstract 1958: Long-Term Survival of Endovascular or Surgical Repair of Abdominal Aortic Aneurysms
Objectives Our objective was to examine long-term outcomes of endovascular (EVAR) and surgical repair of abdominal aortic aneurysms in patients with more advanced risk profiles than in current randomized clinical trials. We determined the 6-year survival and identified predictors of mortality in a large database from a high-volume center.
Methods A retrospective review of elective abdominal aneurysm procedures at our institution between 1998 and 2003 identified 425 AneuRx EVAR and 349 surgical repair patients. In-hospital deaths (2 [0.5%] in EVAR group; 35 [9.1%] in surgical group; p < .0001) were excluded for this analysis. Follow-up was 100% complete (mean 3.4 years; maximum 6 years). Comparison of the long-term survival and correction for differences in baseline variables in the two populations were performed with log-rank testing of Kaplan-Meier survival curves and Cox proportional hazards modeling with propensity adjustment.
Results Unadjusted long-term mortality was higher in EVAR than in surgical patients (6 year mortality: 34% vs 25%; p = 0.041). The EVAR patients had higher incidences of diabetes (16.2% vs. 10.3%; p = 0.0118), hypertension (90.0% vs. 78.5%; p < .0001), smoking (69.6% vs. 48.1%; p < .0001), previous MI (51.1% vs. 28.7%; p < .0001), CHF (22.8% vs. 11.8%; p < .0001), peripheral vascular disease (61.7% vs. 50.7%; p = 0.0023), chronic lung disease (60.1% vs. 34.7%; p < .0001), and previous abdominal surgery (8.8% vs. 0.5%; p < .0001). For EVAR group, an independent predictor for death was presence of CHF (hazard ratio [HR] 2.4 , 95% confidence interval [CI] 1.6–3.5; p < .0001); whereas presence of renal insufficiency (HR 2.2; 95%CI 1.3–3.6; p = 0.002), stroke (HR 2.1; 95%CI 1.1– 4.1, p = 0.003), and chronic lung disease (HR 1.7; 95%CI 1.0 –2.8; p = 0.036) were the independent predictors in the surgical group. After adjustment for risk factors, mortality was similar for the two groups (HR 0.83, 95%CI 0.61–1.14; p = 0.25).
Conclusions Patients who underwent EVAR had more high-risk characteristics compared to surgical group. After adjustment for risk profile, survival after abdominal aneurysm repair using second-generation stent grafts was satisfactory compared to surgical group.