We asked if there is a significant correlation between the increasing trend in aortic repair (AR) and decreasing aortic aneurysm (AA) and aortic dissection (AD) mortality? Therefore, we retrospectively analyzed all aortic repairs in patients with AA and AD and its correlation with disease-specific death rates and hospitalizations for ruptured AA and AD in Germany.
Methods
We retrieved the number of cases hospitalized for AA and AD as well as the procedures in these cases from the Federal Bureau of Statistics (DRG statistics) and death rates from the national mortality statistic published by the Federal Statistical Office in Germany for the years 2006–2017.
Results
From 2006 to 2017, the total number of hospitalized cases admitted with principal diagnosis of AA increased by 25.8% and that of AD by 56.7%. That of cases with the principal diagnosis of ruptured AA (rAA) remained unchanged (−2.5%) and that with rAD increased by 54.6%. The number of (open and endovascular) procedures in cases hospitalized for AA increased by 39.4% and for AD by 126.4%. The age-adjusted death rates in Germany for AA decreased from 4.0 to 2.9 per 100,000 inhabitants and that for AD increased from 1.0 to 1.4. The decrease in death attributed to AA cases can be described by linear regression as y = −0.0003*y + 6.7076 (p < 0.0001). Accepting this association between increased elective procedures and reduced AA mortality, each/all 1000 procedures save 0.3 lives per 100,000 inhabitants.
Conclusion
Despite increasing numbers of AR for AA and AD, only the mortality rate for all AAs decreased, while we did not observe a decrease in overall mortality of AD in Germany.
GäbelGNorthoffBHWeinzierlI, et al.Molecular fingerprint for terminal abdominal aortic aneurysm disease. J Am Heart Assoc2017; 6: e006798.
2.
CikachFSKochCDMeadTJ, et al.Massive aggrecan and versican accumulation in thoracic aortic aneurysm and dissection. JCI Insight2018; 3: e97167.
3.
WanhainenAVerzinFVan HerzeeleI, et al.European society for vascular surgery (esvs) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg. 2019; 57: 8–93.
AbdulameerHTaiiHAAl-KindiSG, et al.Epidemiology of fatal ruptured aortic aneurysms in the United States (1999–2016). J Vasc Surg2019; 69: 378–384.
6.
BeckAWSedrakyanAMaoJ, et al.Variations in abdominal aortic aneurysm care: a report from the international consortium of vascular registries. Circulation2016; 134: 1948–1958.
7.
LesperanceKAndersenCSinghN, et al.Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective. J Vasc Surg2008; 47: 1165–1170.
8.
WendtKKristiansenRKrohg-SørensenK, et al.Trends in abdominal aortic and iliac aneurysm repairs in norway from 2001 to 2013. Eur J Vasc Endovasc Surg2016; 51: 194–201.
9.
BadgerSForsterRBlairPH, et al.Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev2017; 5: CD005261.
10.
ModyPSWangYGeirssonA, et al.Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000–2011. Circ Cardiovasc Qual Outcomes2014; 7: 920–928.
11.
AcostaSGottsäterA. Stable population-based incidence of acute type A and B aortic dissection. Scand Cardiovasc J2019; 53: 274–279.
12.
TadrosROTangGHLBarnesHJ, et al.Optimal treatment of uncomplicated type B aortic dissection: JACC review topic of the week. J Am Coll Cardiol2019; 74: 1494–1504.
13.
PngCYMWuJTangTY, et al.Decrease in mortality from abdominal aortic aneurysms (2001 to 2015): is it decreasing even faster?Eur J Vasc Endovasc Surg2022; S1078-5884(21): 00162–00163.
14.
ChunKCDolanKJSmothersHC, et al.The 10-year outcomes of a regional abdominal aortic aneurysm screening program. J Vasc Surg2019; 70: 1123–1129.
15.
WangGJJacksonBMFoleyPJ, et al.National trends in admissions, repair, and mortality for thoracic aortic aneurysm and type B dissection in the national inpatient sampleJ Vasc Surg2018; 67: 1649–1658.
16.
ErbelRAboyansVBoileauC, et al.ESC committee for practice guidelines 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology. Eur Heart J2014; 35: 2873–2926.
17.
McClureRSBroglySBLajkoszK, et al.Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada: a population-based study. J Thorac Cardiovasc Surg2018; 155: 2254–2264.e4.
18.
ClouseWDHallettJWJrSchaffHV, et al.Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc2004; 79: 176–180.
19.
SchermerhornMLBensleyRPGilesKA, et al.Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995–2008. Ann Surg2012; 256: 651–658.
20.
PngCYMWuJTangTY, et al.Choice - decrease in mortality from abdominal aortic aneurysms (2001 to 2015): is it decreasing even faster?Eur J Vasc Endovasc Surg2021; 61: 900–907.
21.
MullanCWMoriMMahmoodBin, et al.Incidence and characteristics of hospitalization for proximal aortic surgery for acute syndromes and for aneurysms in the USA from 2005 to 2014. Eur J Cardiothorac Surg. 2020; 58: 583–589.
22.
StangAMerrillRMKußO. Nationwide rates of conversion from laparoscopic or vaginal hysterectomy to open abdominal hysterectomy in Germany. Eur J Epidemiol2011; 26: 125–133.
23.
StangAKääb-SanyalVHenseHW, et al.Effect of mammography screening on surgical treatment for breast cancer: a nationwide analysis of hospitalization rates in Germany 2005–2009. Eur J Epidemiol2013; 28: 689–696.
24.
KühnlAErkATrennerM, et al.Incidence, treatment and mortality in patients with abdominal aortic aneurysms. Dtsch Arztebl Int2017; 114: 391–398.
25.
GeisbüschSKühnlASalvermoserM, et al.Increasing incidence of thoracic aortic aneurysm repair in germany in the endovascular era: secondary data analysis of the nationwide German DRG microdata. EJVES2019; 57: 499–509.
26.
GeisbüschSKühnlASalvermoserM, et al.Hospital incidence, treatment, and in hospital mortality following open and endovascular surgery for thoraco-abdominal aortic aneurysms in Germany from 2005 to 2014: secondary data analysis of the nationwide German DRG microdata. EJVES2019; 57: 488–498.
27.
ReutersbergB, SalvermoserTrennerM, et al.Hospital incidence and in-hospital mortality of surgically and interventionally treated aortic dissections: secondary data analysis of the nationwide German diagnosis-related group statistics from 2006 to 2014. JAHA2019; 8: DOI: 10.1161/JAHA.118.011402
28.
Al-BalahAGoodallRSalciccioliJD, et al.Mortality from abdominal aortic aneurysm: trends in European Union 15+ countries from 1990 to 2017Br J Surg. 2020; 107(11): 1459–1467.
29.
GilesKAPomposelliFHamdanA, et al.Decrease in total aneurysm-related deaths in the era of endovascular aneurysm repair. J Vasc Surg2009; 49: 543–550.
30.
DillavouEDMulukSCMakarounMS. A decade of change in abdominal aortic aneurysm repair in the United States: have we improved outcomes equally between men and women?J Vasc Surg2006; 43: 230–238.
31.
RaytHSSuttonAJLondonNJ, et al.A systematic review and meta-analysis of endovascular repair for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg2008; 36: 536–544.
32.
von BeckerathOSchraderSKatohM, et al.Mortality in endovascular and open abdominal aneurysm repair—trends in Germany. Vasa2018; 47: 43–48.
33.
LederleFAKyriakidesTCStroupeKT, et al.OVER veterans affairs cooperative study group. Open versus endovascular repair of abdominal aortic aneurysm. NEJM2019; 380: 2126–2135.
34.
De BruinJLBaasAFButhJ, et al.Long term outcomes of open or endovascular repair of abdominal aortic aneurysm. NEJM2010; 362: 1881–1889.
35.
PatelRSweetingMJSPowellJT, et al.EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15 years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet2016; 388: 2366–2374.
36.
LaineMTLaukontausSJSundRet al.A population-based study of abdominal aortic aneurysm treatment in Finland 2000–2014. Circulation2017; 136: 1726–1734.
37.
BeckAWSedrakyanAMaoJ, et al.Variations in abdominal aortic aneurysm care: a report from the international consortium of vascular registries. Circulation2016; 134: 1948–1958.
38.
JacobsCRScaliSTKhanT, et al.EVAR conversion is an increasingly common indication for open AAA repair. J Vasc Surg2021; S0741-5214(21): 01688–8.
39.
PatelRPowellJTSweetingMJ, et al.The UK endovascular aneurysm repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis healthTechnol Assess. 2018; 22: 1–132.
40.
ElbadawiAElgendyIYJimenezE, et al.Trends and outcomes of elective thoracic aortic repair and acute thoracic aortic syndromes in the United States. Am J Med2021; 134: 902–909.e5.
41.
WangGJJacksonBMFoleyPJ, et al.National trends in admissions, repair, and mortality for thoracic aortic aneurysm and type B dissection in the national inpatient sample. J Vasc Surg2018; 67: 1649–1658.
42.
EvangelistaAIsselbacherEMBossoneE, et al.Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation2018; 137: 1846–1860.
43.
Schmitz-RixenTSteffenMBöcklerD, et al.Registry report from the German institute of vascular healthcare research of the German society for vascular surgery and vascular medicine. Gefässchirurgie2020; 25: 117–123.
44.
Schmitz-RixenTSteffenMBöcklerD, et al.Treatment of the abdominal aortic aneurysm. Register report of the DIGG of the DGG. Vasc Surg2019; 24: 162–172.
45.
MillerCCIIIPoratEEEstreraAL, et al.Number needed to treat: analyzing of the effectiveness of thoracoabdominal aortic repair. Eur J Vasc Endovasc Surg. 2004; 28: 154–157.
46.
BickerstaffLKPairoleroPCHollierLH, et al.Thoracic aortic aneurysms: a population-based study. Surgery1982; 92: 1103–1108.
47.
ThompsonSGAshtonHAGaoL, et al.Multicentre aneurysm screening study group. screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised multicentre aneurysm screening study. BMJ2009; 338: b2307.
