(M) Comparison of Outcomes for Major Contemporary Endograft Devices Used for Endovascular Repair of Intact Abdominal Aortic Aneurysms

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1012

Presenting Author(s)

Michael O. Falster
– Dr, University of New South Wales, UNSW Sydney, Sydney, New South Wales, Australia

Co-Author(s)

Sarah K. Garland
– Centre for Big Data Research in Health, UNSW Sydney, Australia
Louisa Jorm
– Centre for Big Data Research in Health, UNSW Sydney, Australia
C Barry Beiles
– Australian and New Zealand Society for Vascular Surgery, Australia
Anthony J. Freeman
– Australian and New Zealand Society for Vascular Surgery, Australia
Art Sedrakyan
– Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States
Oluwadamisola Sotade
– Centre for Big Data Research in Health, UNSW Sydney, Australia
Ramon L. Varcoe
– Department of Surgery, Prince of Wales Hospital, Australia

Background: Endovascular aortic aneurysm repair (EVAR) is the most common treatment for intact abdominal aortic aneurysm (AAA). While many patients have anatomy suitable for a variety of EVAR endografts, there have been concerns around endoleaks for patient receiving some endograft devices. There is little evidence on outcomes associated with graft choice to guide treatment decisions.

Objectives: To compare rates of mortality, rupture and secondary intervention following EVAR using contemporary endograft devices from three major manufacturers.

Methods: We performed a retrospective cohort study using linked clinical registry (Australasian Vascular Audit) and administrative data. We identified patients undergoing EVAR for intact AAA between 2010-2019 in New South Wales, Australia. We compared all-cause mortality, secondary rupture and secondary intervention rates for patients treated with Medtronic (Endurant), Gore (Excluder) and Cook Medical (Zenith) standard devices. We used inverse probability of treatment weighted proportional hazards and competing risk regression to adjust for patient, clinical and aneurysm characteristics.

Results: We 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 7.0-7.3 per 100 person-years). There was no significant difference between devices in secondary rupture rates, which ranged between 0.4-0.5 per 100 person-years. Patients receiving Medtronic or Gore devices tended to have higher rates of subsequent aneurysm repair (1.5 per 100 person-years) than patients receiving Cook devices (0.8 per 100 person-years), but not all these differences reached statistical significance (HR 1.57, 95% CI 1.02-2.47; HR 1.73, 95% CI 0.94-3.18 respectively).

Conclusions: Major endograft devices have similar overall long-term safety profiles. However, there may be differences in rates of reinterventions for some devices. This may reflect endograft durability, or patient or aneurysm selection for different devices. Continuous comparative assessments are needed to guide evidence for treatment decisions across the range of available devices.