Impact of Introducing Endovascular Aneurysm Repair on Treatment Strategy for Repair of Abdominal Aortic Aneurysm – National Hospital Organization Network Study in Japan –

Nobuhiro Handa; Masafumi Yamashita; Toshiki Takahashi; Toshihiro Onohara; Minoru Okamoto; Tsuyoshi Yamamoto; Yasushi Shimoe; Masahiro Okada; Yoshimitsu Ishibashi; Fuminori Kasashima; Jyunji Kishimoto; Akihiro Mizuno; Jyun-ichi Kei; Mikizou Nakai; Hitoshi Suhara; Masamitsu Endo; Takeshi Nishina; Tadashi Furuyama; Masakazu Kawasaki; Yoichirou Ueno

doi:10.1253/circj.CJ-14-0131

Late Breaking Cohort Studies (JCS 2014)

Impact of Introducing Endovascular Aneurysm Repair on Treatment Strategy for Repair of Abdominal Aortic Aneurysm

– National Hospital Organization Network Study in Japan –

Nobuhiro Handa, Masafumi Yamashita, Toshiki Takahashi, Toshihiro Onohara, Minoru Okamoto, Tsuyoshi Yamamoto, Yasushi Shimoe, Masahiro Okada, Yoshimitsu Ishibashi, Fuminori Kasashima, Jyunji Kishimoto, Akihiro Mizuno, Jyun-ichi Kei, Mikizou Nakai, Hitoshi Suhara, Masamitsu Endo, Takeshi Nishina, Tadashi Furuyama, Masakazu Kawasaki, Yoichirou Ueno

Author information

Nobuhiro Handa
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Masafumi Yamashita
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Toshiki Takahashi
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Toshihiro Onohara
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Minoru Okamoto
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Tsuyoshi Yamamoto
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Yasushi Shimoe
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Masahiro Okada
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Yoshimitsu Ishibashi
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Fuminori Kasashima
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Jyunji Kishimoto
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Akihiro Mizuno
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Jyun-ichi Kei
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Mikizou Nakai
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Hitoshi Suhara
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Masamitsu Endo
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Takeshi Nishina
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Tadashi Furuyama
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Masakazu Kawasaki
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.
Yoichirou Ueno
Affiliations of the National Hospital Organization Network Study Group for Abdominal Aortic Aneurysm in Japan are listed as in the Appendix.

Keywords: Aneurysm, Endovascular therapy, Late-breaking clinical trials, Surgery

JOURNAL FREE ACCESS

2014 Volume 78 Issue 5 Pages 1104-1111

DOI https://doi.org/10.1253/circj.CJ-14-0131

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Abstract

Background: The objective of the present study was to assess the hypothesis that the introduction of endovascular aneurysm repair (EVAR) into Japan has expanded the indication of abdominal aortic aneurysm (AAA) repair without increasing surgical mortality. Methods and Results: From 10 national hospitals, we registered a total of 2,154 consecutive patients (Open surgery [OS]: n=1,577, EVAR: n=577) over 8 years, divided into 4 time periods: Group I (2005–2006: n=522), Group II (2007–2008: n=475), Group III (2009–2010: n=551), Group IV, (2011–2012: n=606). Mean age increased over the 4 time periods (P<0.0001). The incidences of COPD, smoking history, history of abdominal surgery and concomitant malignancy significantly increased as well, while the numbers of patients with preoperative shock or high ASA status reduced over time. The proportion of EVAR in AAA repair increased from: 0% in Group I, 11.6% in Group II, 41.0% in Group III, to 48.8% in Group IV (P<0.0001). Early mortality was 0.8% in the EVAR and 3.4% in the OS (P<0.001) groups. Survival rates among the 4 groups free of all-cause death and aneurysm-related death at 1 year were 92.1–96.3% (P=0.1555) and 95.5–96.8% (P=0.9891), respectively. Multiple logistic regression analysis for surgical death failed to demonstrate survival advantage of EVAR over OS. Conclusions: Introduction of EVAR expanded the indication of AAA repair without increasing mortality, while high risk for anesthesia and emergency cases reduced over time. UMIN-CTR (UMIN000008345) (Circ J 2014; 78: 1104–1111)

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