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Ten-year Comparison of All-Cause Mortality after Endovascular or Open Repair of Abdominal Aortic Aneurysms: A Propensity Score Analysis

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Abstract

Background

This study aimed to compare the long-term survival after open (OS) or endovascular (EVAR) repair of abdominal aortic aneurysms (AAAs), exploring baseline factors that could affect long-term outcome.

Methods

We identified 774 patients (501 EVAR, 273 OS, during 1996–2004) with data on perioperative risk factors including 37 variables assessed with a standardized patient response instrument. Propensity score was used to adjust for baseline differences between the two cohorts. Matched cohorts survival analysis and Cox multivariate regression were performed.

Results

Median follow-up was 6.95 (interquartile range 4.46–9.27) years. EVAR patients were older [75.0 ± 7.7 (SD) vs. 71.3 ± 8.5 years, p < 0.001] and had a higher rate of previous myocardial infarction (39.3 vs. 25.3 %, p < 0.001), pulmonary disease (25.9 vs. 18.3 %, p = 0.020), and history of malignancy (5.0 vs. 1.8 %, p = 0.039). The 30-day mortality was comparable (1.4 % EVAR, 1.5 % OS). Although the unadjusted survival rate was lower (median survival: 7.4 years EVAR, 8.8 OS, p = 0.011) and early (within 4 years) hazard was higher after EVAR (p = 0.003), no difference in survival was observed after propensity score-matching (p = 0.688) or propensity score-adjusted Cox regression (hazard ratio 1.01, 95 % confidence interval 0.82–1.25, p = 0.911, EVAR vs. OS). There was a trend toward higher hazard later in both groups. A multivariate Cox regression identified age, pulmonary disease, stroke, dialysis, oral anticoagulation, cardiac enlargement, and smoking history as variables associated with poor survival. Lipid-lowering medication was found to be protective.

Conclusions

Over long-term follow-up, survivals after endovascular and open repair of AAA are similar. Baseline patient characteristics are correlated with survival, but whether attention to the modifiable risk factor can alter outcome remains to be defined.

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Acknowledgment

The authors express their appreciation to Ji-Sook Kang, research engineer of biostatistics, Medical Research Collaboration Center, Hanyang University, for her kind review and comments on statistics. This work was supported in part from Hanyang university (Clinical Research Fund, HY-2007-6083).

Conflict of interest

Dr. Daniel Clair received consulting fees from Endologix, Medtronic, and Boston Scientific. He is also a member of their Speakers Bureau. Dr. Ouriel’s employer has contractual relationships with Aptus, Cordis, Endologix, and Medtronic. Dr. Lee is a former research fellow at the Cleveland Clinic and received a grant from Hanyang University.

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Authors and Affiliations

  1. Department of Surgery, Hanyang University Guri Hospital, College of Medicine, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-791, Korea

    Hong-Gi Lee

  2. Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Daniel G. Clair

  3. Syntactx, New York, NY, USA

    Kenneth Ouriel

Authors
  1. Hong-Gi Lee
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  2. Daniel G. Clair
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  3. Kenneth Ouriel
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Correspondence to Hong-Gi Lee.

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Lee, HG., Clair, D.G. & Ouriel, K. Ten-year Comparison of All-Cause Mortality after Endovascular or Open Repair of Abdominal Aortic Aneurysms: A Propensity Score Analysis. World J Surg 37, 680–687 (2013). https://doi.org/10.1007/s00268-012-1863-y

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