| アブストラクト | Objectives: Endovascular aortic repair (EVAR) evolved through competition with open aortic repair (OAR) as a safe and effective treatment option for appropriately selected patients with abdominal aortic aneurysm (AAA). Although endoleaks are the most common reason for post-EVAR reintervention, compliance with lifelong regular follow-up imaging remains a challenge. Design: Retrospective data analysis. Setting: The Japan Medical Data Center (JMDC), a claims database with anonymous data linkage across hospitals, consists of corporate employees and their families of </=75 years of age. Participants: The analysis included participants in the JMDC who underwent EVAR or OAR for intact (iAAA) or ruptured (rAAA) AAA. Patients with less than 6 months of records before the aortic repair were excluded. Main outcome measures: Overall survival and reintervention rates. Results: We identified 986 cases (837 iAAA and 149 rAAA) from JMDC with first aortic repairs between January 2015 and December 2020. The number of patients, median age (years (IQR)), follow-up (months) and post-procedure CT scan (times per year) were as follows: iAAA (OAR: n=593, 62.0 (57.0-67.0), 26.0, 1.6, EVAR: n=244, 65.0 (31.0-69.0), 17.0, 2.2), rAAA (OAR: n=110, 59.0 (53.0-59.0), 16.0, 2.1, EVAR: n=39, 62.0 (31.0-67.0), 18.0, 2.4). Reintervention rate was significantly higher among EVAR than OAR in rAAA (15.4% vs 8.2%, p=0.04). In iAAA, there were no group difference after 5 years (7.8% vs 11.0%, p=0.28), even though EVAR had initial advantage. There were no differences in mortality rate between EVAR and OAR for either rAAA or iAAA. Conclusions: Claims-based analysis in Japan showed no statistically significant difference in 5-year survival rates of the OAR and EVAR groups. However, the reintervention rate of EVAR in rAAA was significantly higher, suggesting the need for regular post-EVAR follow-up with imaging. Therefore, international collaborations for long-term outcome studies with real-world data are warranted. |
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| ジャーナル名 | BMJ surgery, interventions, & health technologies |
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| 投稿日 | 2022/8/23 |
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| 投稿者 | Kimura, Yuki; Ohtsu, Hiroshi; Yonemoto, Naohiro; Azuma, Nobuyoshi; Sase, Kazuhiro |
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| 組織名 | Clinical Pharmacology and Regulatory Science, Juntendo University School of;Medicine Graduate School of Medicine, Bunkyo-ku, Japan.;Leading Center for the Development and Research of Cancer Medicine, Juntendo;University, Bunkyo-ku, Japan.;Institute for Medical Regulatory Science, Organization for University Research;Initatives, Waseda University, Wakamatsu-cho, Shinjuku-ku, Japan.;Department of Public Health, Juntendo University School of Medicine Graduate;School of Medicine, Bunkyo-ku, Japan.;National Institute of Mental Health, National Center of Neurology and Psychiatry,;Kodaira, Japan.;Department of Vascular Surgery, Asahikawa Medical University, Midorigaoka higashi;Asahikawa, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/35989874/ |
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