Survival After Endovascular vs Open Aortic Aneurysm Repairs

IMPORTANCE To our knowledge, long-term outcomes of open and endovascular (EVAR) repairs of abdominal aortic aneurysms (AAAs) have not been studied on a population level outside a controlled trial setting. OBJECTIVE To determine long-term outcomes of EVAR vs open repair on a population level. DESIGN, SETTING, AND PARTICIPANTS Analysis of the longitudinally linked California Office of Statewide Health Planning and Development inpatient database from 2001 to 2009. Median follow-up was 3.3 years. EXPOSURES Endovascular vs open repairs. MAIN OUTCOMES AND MEASURES Mortality and complications at 30 days, as well as long-term mortality and complications up to 9 years. RESULTS In this observational study, a total of 23 670 patients were studied, with 52% receiving EVAR. Endovascular repair was associated with improved 30-day outcomes (all-cause mortality, readmission, surgical site infection, pneumonia, and sepsis), as well as significantly improved survival until 3 years postoperatively. After 3 years, mortality was higher for patients who underwent an EVAR repair. No significant difference in long-term mortality was observed for the entire cohort on adjusted analysis (hazard ratio, 0.99; 95% CI, 0.94-1.04; P = .64). Endovascular repair was found to be associated with a significantly higher rate of reinterventions and AAA late ruptures. CONCLUSIONS AND RELEVANCE The survival advantage for EVAR repair in a state wide population is maintained for 3 years. After 3 years, EVAR repair was associated with higher mortality; however, these mortality differences did not reach statistical significance over the entire study period. Reintervention and late AAA rupture rates are higher after EVAR repair.