Eur J Vasc Endovasc Surg. 2022 Nov 2:S1078-5884(22)00732-8. doi: 10.1016/j.ejvs.2022.11.005. Online ahead of print.
OBJECTIVE: To compare rates of mortality, rupture and secondary intervention following endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) using contemporary endograft devices from three major manufacturers.
DESIGN: Retrospective cohort study using linked clinical registry (Australasian Vascular Audit) and all payer administrative data.
METHODS: We identified patients undergoing EVAR for intact AAA between 2010-2019 in New South Wales, Australia. We compared rates of all-cause mortality, secondary rupture and secondary intervention (subsequent aneurysm repair; other secondary aortic intervention) for patients treated with Cook, Medtronic and Gore standard devices. We used inverse probability of treatment weighted proportional hazards and competing risk regression to adjust for patient, clinical and aneurysm characteristics, using Cook as the referent device.
RESULTS: We identified 2,874 eligible EVAR patients, with a median follow-up of 4.1 (maximum 9.5) years. Mortality rates were similar for patients receiving different devices (ranging between 7.0-7.3 per 100 person-years). There was no significant difference between devices in secondary rupture rates, which ranged between 0.4-0.5 per 100 person-years. Patients receiving Medtronic and Gore devices tended to have higher crude rates of subsequent aneurysm repair (1.5 per 100 person-years) than patients receiving Cook devices (0.8 per 100 person-years). This finding remained in the adjusted analysis, but was only statistically significant for Medtronic devices (HR 1.57, 95% CI 1.02-2.47; HR 1.73, 95% CI 0.94-3.18 respectively).
CONCLUSION: Major endograft devices have similar overall long-term safety profiles. However, there may be differences in rates of secondary intervention for some devices. This may reflect endograft durability, or patient selection for different devices based on aneurysm anatomy. Continuous comparative assessments are needed to guide evidence for treatment decisions across the range of available devices.