Dez anos de tratamento de aneurismas da aorta abdominal – exclusão endovascular vs. cirurgia aberta nas diferentes regiões portuguesas

Abstract

Background

Abdominal aortic aneurysms (AAA) affect approximately 5% of men over 65 years of age and are estimated to be the tenth leading cause of mortality in Western countries. Elective surgery either by open repair (OR) or endovascular aneurysm repair (EVAR) is indicated in patients with large AAAs, preventing rupture, the major complication of AAA. To the best of our knowledge a detailed study comparing the treatment choice for AAA repair as well as its associated in‐hospital mortality in Portuguese mainland state hospitals has never been performed.

Aim

The purpose of this analysis was to determine i) the proportion of aneurysm type submitted to repair in each region state hospitals, ii) the proportion of each type of surgical treatment among them, iii) the in‐hospital mortality associated with each treatment.

Methods

All individuals diagnosed with ruptured or non‐ruptured AAAs submitted to either OR or EVAR between 2000 and 2010, whose information was available on an inpatient hospital administrative database, were selected for the study. The database contained data from all Portuguese mainland state hospitals. To evaluate the regional chronological evolution of these data, a yearly characterization for the period between 2000 and 2010 was performed. The type of AAA, its choice of correction and the in‐hospital mortality were evaluated for each national region.

Results

Between the years 2000 and 2010, 3101 AAAs repairs were registered in mainland Portugal. Non‐ruptured AAAs were three times more frequent than ruptured AAAs (75% vs. 25%). Regional comparison showed the non‐ruptured AAA/ruptured AAA ratio in Norte and Lisboa to be significantly higher than that in Centro. Ruptured AAA frequency remained fairly stable during the 11 years evaluated. OR was the preferred method for treatment of both ruptured and non‐ruptured AAAs in all regions. Nevertheless, the choice for EVAR has been increasing from the period of 2005 to 2010, actually becoming the most frequent method in Norte and Lisboa during 2010 (55% in both regions). Ruptured AAAs mortality was similar in all the evaluated regions (52% in Norte, 52% in Centro and 51% in Lisboa). No significant differences were found between EVAR and OR in the repair of ruptured AAA (in‐hospital mortality of 51% in OR vs. 52% in EVAR). A significant improved outcome was obtained with EVAR in the repair of non‐ruptured AAA in state hospitals of Norte and Lisboa (2,1% vs. 6,6% in Norte and 5,0% vs. 8,7% in Lisboa, p < 0,05). No differences were observed in state hospitals of Centro.

Conclusions

The yearly number of AAA repairs in Portuguese mainland state hospitals is increasing across all regions, with EVAR repair consistently gaining prominence. Compared to OR, EVAR presents a more favourable in‐hospital mortality outcome in state hospitals of Norte and Lisboa, when used in elective surgeries for non‐ruptured AAA repairs.