Journal of vascular surgery
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Multicenter Study Comparative Study Observational Study
Treatment choice and survival after ruptured abdominal aortic aneurysm: A population-based study.
The objective of this study was to clarify whether the findings of the randomized studies of repair method (open aortic repair [OAR] vs endovascular aneurysm repair [EVAR]) concerning short-term and midterm survival for ruptured abdominal aortic aneurysms (RAAAs) could be confirmed in a contemporary, nationwide, and unselected population. ⋯ An OAR/EVAR practice for RAAA is not superior to an OAR-only practice with respect to survival at short-term or midterm follow-up. The results are even compatible with an advantage of OAR-only practice vs OAR/EVAR practice for both follow-up periods. There is no extra benefit for either female or elderly patients with an OAR/EVAR practice.
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There is a growing body of literature raising concerns about the long-term durability of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs), suggesting that long-term outcomes may be better after open AAA repair. However, the data investigating these long-term outcomes largely originate from early in the endovascular era and therefore do not account for increasing clinical experience and technologic improvements. We investigated whether 4-year outcomes after EVAR and open repair have improved over time. ⋯ Four-year survival improved in more recent years after EVAR but not after open repair. This finding suggests that midterm outcomes after EVAR are improving, perhaps because of technologic improvements and increased experience, information that should be considered by surgeons and policymakers alike in evaluating the value of contemporary EVAR and open AAA repair.