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Five-year reintervention after endovascular abdominal aortic aneurysm repair in the Vascular Quality Initiative

Columbo, Jesse A.; Ramkumar, Niveditta; Martínez Camblor, Pablo; Kang, Ravinder; Suckow, Bjoern D.; O´Malley, Alistair James; Sedrakyan, Art; Goodney, Philip P.
Abstract:
Objective: Patients who undergo endovascular abdominal aortic aneurysm repair (EVR) remain at risk for reintervention and rupture. We sought to define the 5-year rate of reintervention and rupture after EVR in the Vascular Quality Initiative (VQI). Methods: We identified all patients in the VQI who underwent EVR from 2003 to 2015. We linked patients in the VQI to Medicare claims for long-term outcomes. We stratified patients on baseline clinical and procedural characteristics to identify those at risk for reintervention. Our primary outcomes were 5-year rates of reintervention and late aneurysm rupture after EVR. We assessed these with Kaplan-Meier survival estimation. Results: We studied 12,911 patients who underwent EVR. The mean age was 75.5 years, 79.9% were male, 3.9% were black, and 89.1% of operations were performed electively. The 5-year rate of reintervention for the entire cohort was 21%, and the 5-year rate of late aneurysm rupture was 3%. Reintervention rates varied across categories of EVR urgency. Patients who underwent EVR electively had the lowest 5-year rate of reintervention at 20%. Those who underwent surgery for symptomatic aneurysms had higher rates of reintervention at 25%. Patients undergoing EVR emergently for rupture had the highest rate of reintervention, 27% at 4 years (log-rank across the three groups, P <.001). Black race and aneurysm size of 6.0 cm or greater were associated with significantly elevated reintervention rates (black, 31% vs white, 20% [log-rank, P <.001]; aneurysm size 6.0 cm or greater, 27% vs all others, <20% [log-rank, P <.001]). There were no significant associations between age or gender and the 5-year rate of reintervention. Conclusions: More than one in five Medicare patients undergo reintervention within 5 years after EVR in the VQI; late rupture remains low at 3%. Black patients, those with large aneurysms, and those who undergo EVR urgently and emergently have a higher likelihood of adverse outcomes and should be the focus of diligent long-term surveillance. © 2019 Society for Vascular Surgery
Year:
2019
Type of Publication:
Article
Keywords:
Endovascular abdominal aortic aneurysm repair; Long term outcomes after EVR; Medicare claims; Reintervention; Vascular Quality Initiative; VQI Medicare
Journal:
Journal of Vascular Surgery
Volume:
In press
Note:
Q1 38/203 h-index 3.243 (JCR2018)
DOI:
10.1016/j.jvs.2019.05.057
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