• SCVS Home
• President's Message
• Council
• Commitees
• Annual Meeting
• 37th Annual Symposium
• 36th Annual Symposium
• 35th Annual Symposium
• 34th Annual Symposium
• 33rd Annual Symposium
• Membership
• Join SCVS
• Members Only Area
• Find a Vascular Specialist
• Newsletters
• Journal
• History
• Mission Statement
• Bylaws
• Contact Us
• 37th Annual Symposium
• 36th Annual Symposium
• 35th Annual Symposium
• 34th Annual Symposium
• 33rd Annual Symposium
• Join SCVS
• Members Only Area
• Find a Vascular Specialist

A Population Analysis: Should EVAR Be Performed for Ruptured AAA in the Community at Large?

Objective: We hypothesized there has been an increased use of Endovascular Abdominal Aortic Repair (EVAR) for the treatment of ruptured abdominal aortic aneurysms (rAAA) in the community. We examined the utilization and outcomes of rAAA repair with regard to the implementation of EVAR.
Methods: Retrospective cohort study (2001-2005) using New Jersey State Inpatient Databases (SID) sponsored by the Agency for Healthcare Research and Quality (AHRQ). Characteristics, outcomes, and cost of rAAA repair were evaluated.
Results: 5,176 patients (mean age73.2±8.25, 77.6% male) underwent repair of AAA between 2001 and 2005. A total of 700 repairs (13.5% of all repairs) were performed for rAAA including 618 (88%) cases of open surgery (OS) and 82 (12%) EVAR. For rAAA, there was a 2.3 times increase in the use of EVAR and a 1.9 times decrease in the use of OS over time. Mortality for rAAA was similar for EVAR and OS (45.1%vs.52.4%, p=0.21). Older age (OR=2.9; 95%CI: 1.2-7.0 for age 60-69; OR=5.1; 95%CI: 2.1-12.1 for age 70-79; OR=8.2; 95%CI: 3.4-19.9 for age ≥80), female gender (OR=1.6; 95%CI: 1.1-2.3), and lack of insurance (OR=5.1; 95%CI: 1.7-15.2) were significant predictors of mortality for all rAAA. The cost of repair for rAAA was significantly greater for EVAR compared to OS ($51,339±51,719 vs. $39,967±43,354,p=0.03) and the LOS was similar (14.08±17.97 vs.13.42±18.18; p=0.8).
Conclusion: The treatment of rAAA with EVAR has more than doubled in the community at large. EVAR does not offer a survival benefit as described in single center studies, has a similar LOS, and is significantly more expensive. Further analysis is warranted on a population level to assess the efficacy of EVAR for rAAA in the general community.