World Journal of Surgery

, Volume 36, Issue 4, pp 917–922 | Cite as

Comparison of Survival Rates for Abdominal Aortic Aneurysm Treatment Methods

  • Irene Hinterseher
  • Herold Kuffner
  • Rainer Koch
  • Gabor Gäbel
  • Hans D. Saeger
  • Diane Smelser



We compared relative survival rates of patients after various operative treatments for abdominal aortic aneurysm (AAA) to those for the general population. We calculated a point of “recovery,” defined as the survival rate equal to that of the general population.


Survival data were collected from patients who underwent open repair for a ruptured AAA (rAAA), elective open repair of an AAA (OPEN), and endovascular repair (EVAR) in our hospital between 1995 and 2005. The cumulative relative survival rate and time-specific relative survival rate were calculated for these patients compared to those for the general population. The point of “recovery” was defined as the cumulative relative survival rate equaling the survival rate for the population, and the time-specific relative survival rate reaching 1.0.


The cumulative relative survival rate of the patients immediately after OPEN was lower than for the comparison group at the time the cumulative relative survival rate was regained. The time-specific relative survival rate of the rAAA reached 1.0 at 16 months following emergency surgery, and for OPEN after 10 months. The cumulative relative survival rate in the EVAR group had no impairment following intervention. The relative long-term survival rate in all three surgical groups was the same as that for the general German population.


Patients treated successfully for AAA have the same relative long-term survival as the general population. The time required to reach the same survival, however, differs between the treatment groups and is longest in the group with a rAAA. The variable survival rates should be taken into consideration when treating patients with an AAA.

Supplementary material

268_2012_1477_MOESM1_ESM.doc (78 kb)
Supplementary material 1 (DOC 79 kb)


  1. 1.
    Sakalihasan N, Limet R, Defawe OD (2005) Abdominal aortic aneurysm. Lancet 365:1577–1589PubMedCrossRefGoogle Scholar
  2. 2.
    Alcorn HG, Wolfson SK Jr, Sutton-Tyrrell K et al (1996) Risk factors for abdominal aortic aneurysms in older adults enrolled in the Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 16:963–970PubMedCrossRefGoogle Scholar
  3. 3.
    Cowan JA Jr, Dimick JB, Henke PK et al (2006) Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. Ann N Y Acad Sci 1085:1–10PubMedCrossRefGoogle Scholar
  4. 4.
    Eckstein HH, Bruckner T, Heider P et al (2007) The relationship between volume and outcome following elective open repair of abdominal aortic aneurysm (AAA) in 131 German hospitals. Eur J Vasc Endovasc Surg 34:260–266PubMedCrossRefGoogle Scholar
  5. 5.
    Wilmink T, Claridge MW, Fries A et al (2006) A comparison between the short term and long term benefits of screening for abdominal aortic aneurysms from the Huntingdon Aneurysm screening programme. Eur J Vasc Endovasc Surg 32:16–20PubMedCrossRefGoogle Scholar
  6. 6.
    Office for National Statistics UK (2002) Mortality Statistics: Cause, England and Wales (Series DH2: discontinued), No. 29. Available at: Accessed October 27, 2011
  7. 7.
    Bown MJ, Sutton AJ, Bell PR et al (2002) A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 89:714–730PubMedCrossRefGoogle Scholar
  8. 8.
    Kazmers A, Perkins AJ, Jacobs LA (2001) Aneurysm rupture is independently associated with increased late mortality in those surviving abdominal aortic aneurysm repair. J Surg Res 95:50–53PubMedCrossRefGoogle Scholar
  9. 9.
    Johnston KW (1994) Ruptured abdominal aortic aneurysm: six-year follow-up results of a multicenter prospective study—Canadian Society for Vascular Surgery Aneurysm Study Group. J Vasc Surg 19:888–900PubMedCrossRefGoogle Scholar
  10. 10.
    Mani K, Bjorck M, Lundkvist J et al (2009) Improved long-term survival after abdominal aortic aneurysm repair. Circulation 120:201–211PubMedCrossRefGoogle Scholar
  11. 11.
    Chaikof EL, Brewster DC, Dalman RL et al (2009) SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg 50:880–896PubMedCrossRefGoogle Scholar
  12. 12.
    Lederle FA, Freischlag JA, Kyriakides TC et al (2009) Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302:1535–1542PubMedCrossRefGoogle Scholar
  13. 13.
    Schlosser FJ, Vaartjes I, van der Heijden GJ et al (2010) Mortality after elective abdominal aortic aneurysm repair. Ann Surg 251:158–164PubMedCrossRefGoogle Scholar
  14. 14.
    Schermerhorn ML, O’Malley AJ, Jhaveri A et al (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474PubMedCrossRefGoogle Scholar
  15. 15.
    Adiseshiah M, Boardley D, Agu O et al (2010) Twelve-year outcomes after endovascular aneurysm repair using earliest available endograft components from a single center. J Vasc Surg 52:49–54Google Scholar
  16. 16.
    Greenhalgh RM, Brown LC, Powell JT et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871PubMedCrossRefGoogle Scholar
  17. 17.
    De Bruin JL, Baas AF, Buth J et al (2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 362:1881–1889PubMedCrossRefGoogle Scholar
  18. 18.
    Lagakos S (1992) Statistical analysis of survival data. In: Bailar JC III, Mosteller F (eds) Medical Uses of Statistics, 2nd edn. N Engl J Med Books, Boston, pp 191–281Google Scholar
  19. 19.
    Ederer F, Axtell LM, Cutler SJ (1961) The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6:101–121PubMedGoogle Scholar
  20. 20.
    Buckley JD (1985) Additive and multiplicative models for relative survival rates. Biometrics 40:51–62CrossRefGoogle Scholar
  21. 21.
    Hakulinen T, Tenkanen L (1987) The relative survival rate: a statistical methodology. Natl Cancer Inst Monogr 6:101–121Google Scholar
  22. 22.
    Vaeth M (1998) Excess mortality. In: Armitage P, Colton T (eds) Encyclopedia Biostatistics. Wiley, Chichester, pp 1423–1425Google Scholar
  23. 23.
    Marubini F, Valsecci MG (eds) (1995) Analysing survival data from clinical trials and observational studies. Wiley, ChichesterGoogle Scholar
  24. 24.
    Hakulinen T, Tenkanen L (1987) Regression analysis of relative survival rates. Appl Stat 36:309–317CrossRefGoogle Scholar
  25. 25.
    Dörre F (2002) Jahresbericht 2001 des Tumorzentrums Dresden e.V. In: Geschäftsführender Vorstand des Tumorzentrums Dresden e.V. am Universitätsklinikum Carl Gustav Carus. Bericht des Klinischen Krebsregisters und überregionale Kooperation, DresdenGoogle Scholar
  26. 26.
    Stelzner S, Hellmich G, Koch R et al (2009) Exactitude of relative survival compared with cause-specific survival and competing risk estimations based on a clinical database of patients with colorectal carcinoma. Dis Colon Rectum 52:1264–1271PubMedCrossRefGoogle Scholar
  27. 27.
    Koch R (2001) Analyse von Überlebensdauerverteilungen unter Berücksichtigung der Altersstruktur der Patienten in Klinischen Krebsregistern. Beschreibung der Methodik des Programmes RSURV zur Schätzung und zum Vergleich relativer Überlebensraten. [Analysis of survival period distribution within the clinical cancer registry Dresden.] In: Jahresbericht 2001 des Tumorzentrums Dresden e. V. Available at: Accessed June 21, 2011
  28. 28.
    Koch R (2005)Schätzung und Vergleich von relativen Überlebensraten in der Langzeitbeobachtung Klinischer Krebsregister [Estimation and comparison of relative survival rates in long-term observation.] In: Jahresbericht 2004/2005 des Tumorzentrums Dresden e. V., Dresden, pp 143–152. Available at: Accessed June 21, 2011
  29. 29.
    Voutilainen ET, Dickmann PW, Hakulinen T (2000) SURV3: relative survival analysis program. Software manualGoogle Scholar
  30. 30.
    Schön D, Bertz J, Görsch B et al (1999) Entwicklung der Überlebensraten von Krebspatienten in Deutschland. Robert Koch Institut, BerlinGoogle Scholar
  31. 31.
    Derubertis BG, Trocciola SM, Ryer EJ et al (2007) Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. J Vasc Surg 46:630–635PubMedCrossRefGoogle Scholar
  32. 32.
    Hannawa KK, Eliason JL, Upchurch GR Jr (2009) Gender differences in abdominal aortic aneurysms. Vascular 17(Suppl 1):30–39CrossRefGoogle Scholar
  33. 33.
    Lederle FA, Larson JC, Margolis KL et al (2008) Abdominal aortic aneurysm events in the women’s health initiative: cohort study. BMJ 337:1724CrossRefGoogle Scholar
  34. 34.
    Ten Bosch JA, Teijink JA, Willigendael EM et al (2010) Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients. J Vasc Surg 52:13–18PubMedCrossRefGoogle Scholar
  35. 35.
    Wibmer A, Schoder M, Wolff KS et al (2008) Improved survival after abdominal aortic aneurysm rupture by offering both open and endovascular repair. Arch Surg 143:544–549PubMedCrossRefGoogle Scholar
  36. 36.
    Moore R, Nutley M, Cina CS et al (2007) Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. J Vasc Surg 45:443–450PubMedCrossRefGoogle Scholar
  37. 37.
    Beck AW, Goodney PP, Nolan BW et al (2009) Predicting 1-year mortality after elective abdominal aortic aneurysm repair. J Vasc Surg 49:838–843PubMedCrossRefGoogle Scholar
  38. 38.
    Karthikesalingam A, Holt PJ, Hinchliffe RJ et al (2010) Risk of reintervention after endovascular aortic aneurysm repair. Br J Surg 97:657–663PubMedCrossRefGoogle Scholar
  39. 39.
    Tavris DR, Liu CH, Gross TP et al (2010) Aneurysm-related mortality rates in the US AneuRx clinical trial. J Am Coll Surg 211:646–651PubMedCrossRefGoogle Scholar
  40. 40.
    Mertens J, Houthoofd S, Daenens K et al (2011) Long-term results after endovascular abdominal aortic aneurysm repair using the Cook Zenith endograft in a single-center experience. J Vasc Surg 54:48–57PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Irene Hinterseher
    • 1
  • Herold Kuffner
    • 2
  • Rainer Koch
    • 3
  • Gabor Gäbel
    • 1
  • Hans D. Saeger
    • 1
  • Diane Smelser
    • 4
  1. 1.Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav CarusTechnical University of DresdenDresdenGermany
  2. 2.Department of Surgery, Hospital of BautzenAcademic Teaching Hospital of the Technical University of DresdenBautzenGermany
  3. 3.Institute of Medical Statistics and BiometryTechnical University of DresdenDresdenGermany
  4. 4.Weis Center for ResearchGeisinger Medical CenterDanvilleUSA

Personalised recommendations