Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries
Authors' conclusion
Despite homogeneous guidelines from professional societies, significant variation exists in the management of AAA, most notably for iAAA diameter at repair, use of EVAR, and the treatment of elderly patients.
Study context
- Population
- Patients undergoing open or endovascular abdominal aortic aneurysm (AAA) repair in 11 countries, 2010–2013
- Participants
- 51,153 patients · 11 countries
- Exposure
- Variation in AAA management across countries and centres
- Outcome
- Variation in AAA management
Methodological detailsinternational, multicentre, 11 vascular surgical quality registries
- International
- Multicentre
- 11 vascular surgical quality registries
Main finding
As reported in the abstract
- Intact AAA
- 86%
- Ruptured AAA
- 14%
- Women (range 12% Switzerland–21% US; P<0.01)
- 18%
- Men with iAAA repaired below guideline diameter (<5.5 cm; range 6% Iceland–41% Germany; P<0.01)
- 31%
- Women with iAAA repaired below guideline diameter (<5 cm; range 0% Iceland–16% US; P<0.01)
- 12%
- Endovascular AAA repair (EVAR) use for iAAA, range 28% Hungary–79% US
- P<0.01
- EVAR use for ruptured AAA, range 5% Denmark–52% US
- P<0.01
- Octogenarians (range 12% Hungary–29% Australia; P<0.01)
- 23%
- Correlation of small AAA repair with EVAR use across countries (trend; P=0.14)
- 0.51
Observational data: associations, not effects.
Further findings
Small AAA repair and octogenarian iAAA repair by reimbursement system
- Small AAA repair, fee-for-service countries
- 33%
- Small AAA repair, population-based reimbursement countries
- 16%
- Octogenarians undergoing iAAA repair, fee-for-service countries
- 25%
- Octogenarians, population-based reimbursement countries
- 18%
- P<0.01
- Fee-for-service: Australia, Germany, Switzerland, US
Original publication
Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. Circulation. Published 26 October 2016. doi:10.
Summarised from the published abstract; every number is checked against it