• Annals of surgery · Aug 2021

    Nationwide Study of Ruptured Abdominal Aortic Aneurysms During Twenty Years (1994-2013).

    • Kim Gunnarsson, Anders Wanhainen, Martin Björck, Khatereh Djavani-Gidlund, and Kevin Mani.
    • Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    • Ann. Surg. 2021 Aug 1; 274 (2): e160e166e160-e166.

    ObjectiveTo analyze the epidemiology of ruptured abdominal aortic aneurysms (RAAA) in Sweden over 20 years, and assess the effect of endovascular repair (EVAR) on surgical treatment rate and outcome.MethodsAll Swedish citizens >50 years with RAAA 1994 to 2013 were extracted from 3 national (Cause of Death, Patient, and Vascular Surgical) registries. Incidence, proportion repaired, surgical techniques, and 90-day mortality were assessed based on sex and age groups, with regression analysis.Results18,726 individuals with RAAA were identified, 74.0% men. The incidence of RAAA decreased from 33.1/100,000: 1994 to 21.3/100,000: 2013 (relative change -35.6%, P < 0.001). The proportion of men with RAAA undergoing repair was 44.5%: 1994-1998, 49.7%: 2009-2013 (+11.7%, P < 0.001). In women, 22.3% were repaired in 1994-1998, versus 28.2%: 2009-2013 (+26.4%, P < 0.001). The proportion undergoing repair increased in octogenarians (men: +44.3%, P < 0.001; women +49.3%, P = 0.001). EVAR increased from 0% initially to 42.3% in men and 41.2% in women 2013. Overall, mortality rate among all individuals with RAAA decreased, men 75.8%: 1994-1998, 64.8%: 2009-2013 (-14.5%, P < 0.001); women 88.5%: 1994-1998, 82.2%: 2009-2013 (-7.1%, P < 0.001). Among those who underwent repair, mortality was 47.0% in men: 1994-1998, 31.8%: 2009-2013 (-32.3%, P < 0.001); women 51.8%: 1994-1998, 41.4%: 2009-2013 (-20.1%, P = 0.010).ConclusionRAAA mortality among men decreased, mainly attributed to falling incidence of RAAA. The mortality was further reduced by more patients being offered repair, increasingly often with EVAR, and improved survival after repair. Incidence of rupture remained unchanged among women, who had higher RAAA mortality. Focused efforts to reduce RAAA mortality among women are warranted.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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