A Population-Based Study of Abdominal Aortic Aneurysm Treatment in Finland 2000-2014

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-10, Vol.136 (18), p.1726-1734
• Main Authors: Laine, Matti T, Laukontaus, Sani J, Sund, Reijo, Aho, Pekka S, Kantonen, Ilkka, Albäck, Anders, Venermo, Maarit
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Female; Finland - epidemiology; Humans; Incidence; Male; Middle Aged; Registries; Sex Factors
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.117.028259

BACKGROUND—In the event of rupture of an abdominal aortic aneurysm (AAA), mortality is very high. AAA prevalence and incidence of ruptures has been reported to be decreasing. The treatment of AAA has also undergone a change in recent decades with a shift towards endovascular aneurysm repair (EVAR). Our aim was to evaluate how these changes have affected the elective and emergency treatment of AAA and their results in Finland. METHODS—All patients treated for AAA in Finland, a country with a population of 5.5 million, during 2000-2014 were searched from the registry of the Finnish Institute for Health and Welfare. Data on all patients who had died due to AAA during the same time period was obtained from Statistics Finland. The data was combined and analyzed. RESULTS—The annual incidence of ruptured AAA was 16.4 per 100 000 population over 50 years and decreased significantly during the study period. Over half of the 4949 patients who suffered a ruptured AAA died outside the hospital. Thirty-day mortality after emergency repair was 39.4%. Intact AAA repair numbered 4956. The absolute number of annual repairs increased during the study period and the use of EVAR became the dominant method of elective repair. Thirty-day mortality in elective AAA repair dropped significantly from 6.3% in 2000-2004 to 2.7% in 2010-2014 mostly due to increase number of EVAR procedures with lower mortality. Long-term mortality in patients treated with EVAR was higher than in patients treated with open repair. Mortality after elective AAA repair was primarily due to cardiovascular causes but there was a slightly higher proportion of AAA-related late deaths in EVAR patients. CONCLUSIONS—Ruptured AAA incidence for men over 65 years has declined with nearly 30% in Finland, likely due to decrease in AAA prevalence. The treatment results have improved as well for both elective and emergency repair. Increased use of EVAR has resulted in decrease of mortality after elective AAA repair, but results of open repair have improved as well. However, late mortality from elective EVAR is surprisingly high compared to open repair which may have been exaggerated by patient selection.