Journal
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Volume 65, Issue 2, Pages 272-280Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.ejvs.2022.11.005
Keywords
Abdominal; Aortic aneurysm; Blood vessel prosthesis implantation; Retrospective studies
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This study compares the rates of mortality, rupture, and secondary intervention in patients undergoing endovascular repair of intact abdominal aortic aneurysms using different endograft devices. The results show that the overall long-term safety profiles of major endograft devices are similar. However, there may be differences in rates of secondary intervention, with higher rates observed in patients receiving Medtronic and Gore devices.
Objective: To compare rates of mortality, rupture, and secondary intervention following endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) using contemporary endograft devices from three major manufacturers. Methods: This was a retrospective cohort study using linked clinical registry (Australasian Vascular Audit) and all payer administrative data. Patients undergoing EVAR for intact AAA between 2010 and 2019 in New South Wales, Australia were identified. Rates of all cause death, secondary rupture, and secondary intervention (subsequent aneurysm repair; other secondary aortic intervention) were compared for patients treated with Cook, Medtronic, and Gore standard devices. Inverse probability of treatment weighted proportional hazards and competing risk regression were used to adjust for patient, clinical, and aneurysm characteristics, using Cook as the referent device. Results: This study identified 2 874 eligible EVAR patients, with a median follow up of 4.1 (maximum 9.5) years. Mortality rates were similar for patients receiving different devices (ranging between 7.0 and 7.3 per 100 person years). There was no statistically significant difference between devices in secondary rupture rates, which ranged between 0.4 and 0.5 per 100 person years. Patients receiving Medtronic and Gore devices tended to have higher crude rates of subsequent aneurysm repair (1.5 per 100 person years) than patients receiving Cook devices (0.8 per 100 person years). This finding remained in the adjusted analysis, but was only statistically significant for Medtronic devices (HR 1.57, 95% CI 1.02 -2.47; HR 1.73, 95% CI 0.94 -3.18, respectively). Conclusion: Major endograft devices have similar overall long term safety profiles. However, there may be differences in rates of secondary intervention for some devices. This may reflect endograft durability, or patient selection for different devices based on aneurysm anatomy. Continuous comparative assessments are needed to guide evidence for treatment decisions across the range of available devices.
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