Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003

John A. Cowan, Justin B. Dimick, Peter K. Henke, John Rectenwald, James C. Stanley, Gilbert R. Upchurch

Research output: Chapter in Book/Report/Conference proceedingConference contribution

73 Citations (Scopus)

Abstract

The epidemiology of abdominal aortic aneurysm (AAA) disease has been well described over the preceding 50 years. This disease primarily affects elderly males with smoking, hypertension, and a positive family history contributing to an increased risk of aneurysm formation. The aging population as well as increased screening in high-risk populations has led some to suggest that the incidence of AAAs is increasing. The National Inpatient Sample (1993-2003), a national representative database, was used in this study to determine trends in mortality following AAA repair in the United States. In addition, the impact of the introduction of less invasive endovascular AAA repair was assessed. Overall rates of treated unruptured and ruptured AAAs remained stable (unruptured 12 to 15/100,000; ruptured 1 to 3/100,000). In 2003, 42.7% of unruptured and 8.8% of ruptured AAAs were repaired through an endovascular approach. Inhospital mortality following unruptured AAA repair continues to decline for open repair (5.3% to 4.7%, P = 0.007). Mortality after elective endovascular AAA repair also has statistically decreased (2.1% to 1.0%, P = 0.024) and remains lower than open repair. Mortality rates for ruptured AAAs following repair remain high (open: 46.5% to 40.7%, P = 0.01; endovascular: 40.0% to 35.3%, P = 0.823). These data suggest that the numbers of patients undergoing elective AAA repair have remained relatively stable despite the introduction of less invasive technology. A shift in the treatment paradigm is occurring with a higher percentage of patients subjected to elective endovascular AAA repair compared to open repair. This shift, at least in the short term, appears justified as the mortality in patients undergoing elective endovascular AAA repair is significantly reduced compared to patients undergoing open AAA repair.

Original languageEnglish (US)
Title of host publicationThe Abdominal Aortic Aneurysm
Subtitle of host publicationGenetics, Pathophysiology, and Molecular Biology
Pages1-10
Number of pages10
Volume1085
DOIs
StatePublished - Nov 1 2006

Publication series

NameAnnals of the New York Academy of Sciences
Volume1085
ISSN (Print)0077-8923
ISSN (Electronic)1749-6632

Fingerprint

Epidemiology
Aortic Aneurysm
Abdominal Aortic Aneurysm
Repair
Mortality
Aortic Diseases
Hospital Mortality
Population
Aneurysm
Inpatients
Smoking
Databases
Hypertension
Technology
Screening
Aging of materials

Keywords

  • Abdominal aortic aneurysm
  • Endovascular
  • Repair

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Cowan, J. A., Dimick, J. B., Henke, P. K., Rectenwald, J., Stanley, J. C., & Upchurch, G. R. (2006). Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. In The Abdominal Aortic Aneurysm: Genetics, Pathophysiology, and Molecular Biology (Vol. 1085, pp. 1-10). (Annals of the New York Academy of Sciences; Vol. 1085). https://doi.org/10.1196/annals.1383.030

Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. / Cowan, John A.; Dimick, Justin B.; Henke, Peter K.; Rectenwald, John; Stanley, James C.; Upchurch, Gilbert R.

The Abdominal Aortic Aneurysm: Genetics, Pathophysiology, and Molecular Biology. Vol. 1085 2006. p. 1-10 (Annals of the New York Academy of Sciences; Vol. 1085).

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Cowan, JA, Dimick, JB, Henke, PK, Rectenwald, J, Stanley, JC & Upchurch, GR 2006, Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. in The Abdominal Aortic Aneurysm: Genetics, Pathophysiology, and Molecular Biology. vol. 1085, Annals of the New York Academy of Sciences, vol. 1085, pp. 1-10. https://doi.org/10.1196/annals.1383.030
Cowan JA, Dimick JB, Henke PK, Rectenwald J, Stanley JC, Upchurch GR. Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. In The Abdominal Aortic Aneurysm: Genetics, Pathophysiology, and Molecular Biology. Vol. 1085. 2006. p. 1-10. (Annals of the New York Academy of Sciences). https://doi.org/10.1196/annals.1383.030
Cowan, John A. ; Dimick, Justin B. ; Henke, Peter K. ; Rectenwald, John ; Stanley, James C. ; Upchurch, Gilbert R. / Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. The Abdominal Aortic Aneurysm: Genetics, Pathophysiology, and Molecular Biology. Vol. 1085 2006. pp. 1-10 (Annals of the New York Academy of Sciences).
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title = "Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003",
abstract = "The epidemiology of abdominal aortic aneurysm (AAA) disease has been well described over the preceding 50 years. This disease primarily affects elderly males with smoking, hypertension, and a positive family history contributing to an increased risk of aneurysm formation. The aging population as well as increased screening in high-risk populations has led some to suggest that the incidence of AAAs is increasing. The National Inpatient Sample (1993-2003), a national representative database, was used in this study to determine trends in mortality following AAA repair in the United States. In addition, the impact of the introduction of less invasive endovascular AAA repair was assessed. Overall rates of treated unruptured and ruptured AAAs remained stable (unruptured 12 to 15/100,000; ruptured 1 to 3/100,000). In 2003, 42.7{\%} of unruptured and 8.8{\%} of ruptured AAAs were repaired through an endovascular approach. Inhospital mortality following unruptured AAA repair continues to decline for open repair (5.3{\%} to 4.7{\%}, P = 0.007). Mortality after elective endovascular AAA repair also has statistically decreased (2.1{\%} to 1.0{\%}, P = 0.024) and remains lower than open repair. Mortality rates for ruptured AAAs following repair remain high (open: 46.5{\%} to 40.7{\%}, P = 0.01; endovascular: 40.0{\%} to 35.3{\%}, P = 0.823). These data suggest that the numbers of patients undergoing elective AAA repair have remained relatively stable despite the introduction of less invasive technology. A shift in the treatment paradigm is occurring with a higher percentage of patients subjected to elective endovascular AAA repair compared to open repair. This shift, at least in the short term, appears justified as the mortality in patients undergoing elective endovascular AAA repair is significantly reduced compared to patients undergoing open AAA repair.",
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