The effect of widespread use of EVAR on aneurysm-related mortality in the last decade: A nationwide big data platform-based analysis

Abstract

Abstract The introduction of endovascular aneurysm repair (EVAR) for the treatment of abdominal aortic aneurysms (AAA) has led to a dramatic decline in open aneurysm repair (OAR). However, there was no report on the trend of AAA-related mortality after the introduction of EVAR. The aim of this study is to evaluate the trends of annual AAA treatment and AAA-related morality including ruptured AAA (rAAA) and intact AAA (iAAA) last decade. We conducted a serial, cross-sectional study with a time trend of patients who were managed with AAA and underwent aneurysm repair including EVAR and OAR between 2010 and 2020. Data from the Health Insurance Review and Assessment Service (HIRA) were used to evaluate AAA management and repair trends. Data on the annual mortality due to rAAA and iAAA were obtained from Statistics Korea. We evaluated the annual mortality due to AAA and morality rate after the management of rAAA. A linear-by-linear association was performed to determine the changes in the rate of these aneurysm repair techniques. The annual number of patients with iAAA and rAAA increased from 3,686 to 10,630 and 462 to 750 patients, respectively. The number of patients with AAA repair increased from 931 in 2010 to 2,050 in 2020 (OAR; 525 in 2010 to 822 in 2020 and EVAR; 406 in 2010 to 1,228 in 2020). The percentage of EVAR for the treatment of AAA increased from 43.6% in 2010 to 59.9% in 2020. The annual number of AAA-related mortal patients increased from 213 in 2010 to 301 in 2020. However, the annual AAA-related mortality rate decreased from 5.1% in 2010 to 2.6% in 2020. The mortality rate after the management of rAAA did not change during this period (mean mortality rate, 35.7%). During the last decade in Korea, the number of patients with AAA and AAA repair increased. In addition, the AAA-related mortal case increased. But, the AAA-related mortality rate decreased after the increasing trend of EVAR procedure. The nationwide mortality rate after the management of rAAA does not change.