Log in to MyACC
Prevalence of AAA Repair by Age and Sex
Study Questions:
What was the prevalence of elective and ruptured abdominal aortic aneurysm (RAAA) repairs by age and sex from 2003 to 2016 in Ontario, Canada?
Methods:
The investigators used a retrospective, population-based, cross-sectional, time-series analysis in Ontario, Canada, from April 1, 2003, to March 31, 2016, and included all patients undergoing AAA repair who were ages >39 years. Data on EAAA and RAAA repair with open surgical repair (OSR) or endovascular aortic repair (EVAR) were collected. The main outcomes and measures were age- and sex-standardized rates of EAAA and RAAA repair with OSR and EVAR. To examine the presence of statistically significant trends within each group, autoregressive integrated moving average (ARIMA) models were fit with linear or quadratic trend regressors as dictated by visual inspection of graphical data.
Results:
From 2003 to 2016, 19,489 EAAA repairs (12,232 [63%] OSR and 7,257 [37%] EVAR) and 2,732 RAAA repairs (2,466 [90%] OSR and 266 [10%] EVAR) were identified. The mean (standard deviation) age was 72.7 (8.1) years in the EAAA subgroup and 73.5 (8.9) years in the RAAA subgroup; 15,813 patients (81%) in the EAAA subgroup and 2,178 (80%) in the RAAA subgroup were men. The rates of EAAA by age quintile and sex decreased over the study period except among patients >79 years (1.3 per 100,000 population in 2003 to 2.2 per 100,000 population in 2016; 70% increase; p < 0.001). The rates of elective OSR decreased across all age and sex subgroups (range, 38%-74% decrease; p ≤ 0.009 for all subgroups) except among patients >79 years (1.3 per 100,000 population at baseline to 0.56 per 100,000 population in the second quarter of 2016; 53% decrease; p = 0.05). The rates of elective EVAR significantly increased across all age and sex subgroups (range, 566%-1,585% increase; p ≤ 0.04 for all subgroups). Elective EVAR became the dominant treatment approach for aneurysms in men around 2010, whereas it maintained parity among women in 2016. The RAAA repair rate decreased over the study period in all subgroups (range, 32%-91% decrease; p ≤ 0.001 for all subgroups), but the decrease was not significant among women (80% decrease; p = 0.08). Similarly, the rates of ruptured OSR decreased among all subgroups (range, 47%-91% decrease; p < 0.001), but the decrease was not significant among women (87% decrease; p = 0.54). Ruptured EVAR showed significant uptake in all subgroups.
Conclusions:
The authors concluded that among patients with AAA in Ontario, Canada, use of EVAR appeared to increase from 2003 to 2016, whereas OSR use appeared to decrease.
Perspective:
This population-level time-series analysis of >20,000 AAA repairs reports an overall shift toward EVAR in all age and sex subgroups undergoing EAAA and RAAA repair. The greatest increases were observed among patients undergoing EAAA repair who were ages >79 years and among women. However, the proportion of EAAA repairs among women that were conducted by elective EVAR was still lower than that among men, possibly related to continued graft-related restrictions for more widespread application of EVAR in women. Overall, these and other data suggest that endovascular repair may be the preferred method for elective and ruptured aneurysm repair, particularly among older individuals, for elective repairs in men, and for ruptured repairs in women.
Keywords: Aortic Aneurysm, Abdominal, Aortic Rupture, Cardiac Surgical Procedures, Elective Surgical Procedures, Endovascular Procedures, Geriatrics, Secondary Prevention, Vascular Diseases
< Back to Listings
