open access publication

Article, 2024

Effect of EVAR on International Ruptured AAA Mortality—Sex and Geographic Disparities

Journal of Clinical Medicine, ISSN 2077-0383, Volume 13, 9, Page 2464, 10.3390/jcm13092464

Contributors

Png, Chien Yi Maximilian 0000-0002-2163-7102 (Corresponding author) [1] Pendleton, Anna Alaska [1] Altreuther, Martin E 0000-0001-8879-7699 [2] Budtz-Lilly, Jacob William 0000-0002-6181-6391 [3] Gunnarsson, Kim [4] Kan, Chung-Dann 0000-0002-2092-0977 [5] [6] Khashram, Manar 0000-0003-4921-8433 [7] Laine, Matti T 0009-0003-2218-3282 [8] Mani, Kevin [4] Pederson, Christian C. [9] Srivastava, Sunita D [1] Eagleton, Matthew Jeremiah [1]

Affiliations

  1. [1] Massachusetts General Hospital
    2. [NORA names: United States; America, North; OECD];
  2. [2] St Olav's University Hospital
    3. [NORA names: Norway; Europe, Non-EU; Nordic; OECD];
  3. [3] Aarhus University Hospital
    4. [NORA names: Central Denmark Region; Hospital; Denmark; Europe, EU; Nordic; OECD];
  4. [4] Uppsala University
    5. [NORA names: Sweden; Europe, EU; Nordic; OECD];
  5. [5] National Cheng Kung University
    6. [NORA names: Taiwan; Asia, East];

Abstract

Background: We sought to investigate the differential impact of EVAR (endovascular aneurysm repair) vis-à-vis OSR (open surgical repair) on ruptured AAA (abdominal aortic aneurysm) mortality by sex and geographically. Methods: We performed a retrospective study of administrative data on EVAR from state statistical agencies, vascular registries, and academic publications, as well as ruptured AAA mortality rates from the World Health Organization for 14 14 states across Australasia, East Asia, Europe, and North America. Results: Between 2011-2016, the proportion of treatment of ruptured AAAs by EVAR increased from 26.1 to 43.8 percent among females, and from 25.7 to 41.2 percent among males, and age-adjusted ruptured AAA mortality rates fell from 12.62 to 9.50 per million among females, and from 34.14 to 26.54 per million among males. The association of EVAR with reduced mortality was more than three times larger (2.2 vis-à-vis 0.6 percent of prevalence per 10 percentage point increase in EVAR) among females than males. The association of EVAR with reduced mortality was substantially larger (1.7 vis-à-vis 1.1 percent of prevalence per 10 percentage point increase in EVAR) among East Asian states than European+ states. Conclusions: The increasing adoption of EVAR coincided with a decrease in ruptured AAA mortality. The relationship between EVAR and mortality was more pronounced among females than males, and in East Asian than European+ states. Sex and ethnic heterogeneity should be further investigated.

Keywords

AAA, AAA mortality, America, Asia, Asian states, Australasia, EVAR, East, East Asia, East Asian states, Europe, Health Organization, International, North, North America, OSR, Statistics Agency, World Health Organization, academic publications, administrative data, agencies, association, data, decrease, differential impact, disparities, effect, ethnic heterogeneity, females, geographic disparities, geographically, heterogeneity, increasing adoption, male, mortality, mortality rate, organization, proportion, publications, rate, reduce mortality, registry, relationship, retrospective study, retrospective study of administrative data, ruptured AAA, sex, state, state statistical agencies, study of administrative data, vascular registry, world

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