Tracking the Decline of AAA Repair in the United States

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Has the advent of branched-fenestrated aortic endografts increased the number of abdominal aortic aneurysm (AAA) repairs due to patients who otherwise would not be offered open repair or infrarenal endovascular repair (EVAR)?

This is the question addressed by Dr. Bjoern D. Suckow, who will present the results of a study that he and his colleagues at the Dartmouth-Hitchcock Medical Center performed to evaluate trends in open AAA repair, EVAR, and branched-fenestrated EVAR (BEVAR) for AAA in Medicare beneficiaries from 2003 to 2013. They used a 100% sample of Medicare Part B claims to determine the number of each of these repair types and to compare them annually over the study period.

Between 2003 and 2013, the total number of AAA repairs significantly declined by 13% from 27,352 to 23,835, after a peak number of 29,924 repairs performed in 2005. The number of open AAA repairs significantly and steadily declined by 78%, from 15,385 in 2003 to 3,315 in 2013. In contrast, while the number of EVARs significantly increased from 11,967 in 2003 to 20,845 in 2008, that number has since declined a total of 13% to only 18,098 repairs in 2013, although this was not a significant difference.

Prior to 2011, there were no BEVAR cases among Medicare beneficiaries, according to Dr. Suckow. However, the number of BEVAR cases continuously and significantly rose more than 500% from 401 procedures in 2011 to 2,422 procedures in 2013. Over this same time period, the number of open repairs and the number of EVARs declined by 2,499 and 2,415 cases, respectively .

“The total number of AAA repairs in the Unites States has been declining annually since 2005,” said Dr. Suckow. “Our study shows that the continuous increase in BEVAR cases performed among Medicare patients over the last 3 years has not reversed the steady decline in overall numbers of AAA repairs, because of a concomitant decline in both open aneurysm repair and EVAR.”

Their results indicated that BEVAR was not likely responsible for the overall decline in open repair, as this trend was found to be present over a much longer time period, according to Dr. Suckow. Similarly, the rapid rise in BEVAR cases occurred when there was an almost equal decline in EVAR case numbers.

“These trends suggest a potential decline in the incidence of AAA in the U.S. Medicare population, with shifts in the type of repair based on available technology and perhaps patient preference,” said Dr. Suckow. “Future efforts are needed to determine the characteristics of patients treated with BEVAR as well as the long-term effectiveness of these new treatments,” he concluded.

Friday: Plenary Session 4
8:00 A.M. – 9:30 A.M.
Potomac Ballroom A/B

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