A Direct Comparison of Long-Term Survival for Major Contemporary EVAR Devices Using Big Data and Linkage Techniques

Endovascular aneurysm repair (EVAR) is the standard treatment method for abdominal aortic aneurysms (AAA) as it reduces perioperative morbidity and mortality with less blood loss and ICU use, and fewer limitations. There are currently no direct comparison studies of current EVAR devices and those observational studies that do exist have many limitations. Some compare older stent grafts no longer in use, have small sample sizes at single institutions, or focus on in-hospital patient outcomes. No current studies investigated long-term mortality with current EVAR devices.

According to Ramon L. Varcoe, MBBS, MS, PhD, MMed (ClinEpi) at ISET 2023, the aim of his study was to use linked clinical registries and administrative data to investigate the primary endpoint—differences in long-term all-cause mortality between contemporary EVAR stent-graft devices. It also examined secondary intervention rates and secondary aortic rupture rates.

This data linkage study used admitted patient data collection; the NSW registry of births, deaths, and marriages; and the NSW cause of death unit record file. These records show all inpatient episodes in NSW hospitals, demographics, diagnoses, procedures performed, and all deaths, including the underlying cause and contributing causes.

Between 2010 and 2019, there were 2,874 EVAR procedures for intact AAA. Medtronic and the Complex Cook grafts had the majority of >60 mm AAA while more patients with a Standard Cook device had high ASA scores. After propensity score matching EVAR, open surgical repair patient characteristics, all-cause mortality, cause-specific mortality, and AAA specific mortality were similar among groups.

The data comparison ultimately showed no difference in long-term mortality between contemporary endografts. There was also no difference in secondary intervention rates. Subsequent aneurysm repair was higher in the Medtronic and Gore groups.