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State Of The Aaa: A Population Based Study Of Trends In Diagnosis, Treatment And Mortality Spanning 4 Decades
Indrani Sen, Jill Colglazier, Randall DeMartino, Fahad Shuja, Bernardo Mendes, Mellinda Schaller, Todd Rasmussen, Thomas Bower, Jennifer St Sauver, William Harmsen, Jay Mandrekar, Manju Kalra.
Mayo clinic, Rochester, MN, USA.

Background: The impact of screening and endovascular therapy on the epidemiology of AAA at a population level have not been evaluated. Methods: A population-based cohort study was conducted (1980-2017) of all patients with AAA identified using ICD 9/10 and CPT codes. Review of medical records, imaging and death certificates confirmed diagnosis, incidence and late events. Results: The study included 1537 patients (75% male; median age 74 years). Overall age and sex-adjusted AAA incidence was 59/ 100,000 patient-years, 4.5 times higher in men than women. Age and sex-adjusted incidence of ruptured AAA was 4/100,000 patient years (7:1, M: F), with a sharp decline from 12/100,000 patient years before 2000 to 0.4/100,000 patient years after (p< 0.001). Diagnosis of AAA was made at presentation with rupture in 95 patients, of which 75% presenting before and 66% after 2007 satisfied current Medicare established ultrasound screening criteria. Overall, only 16% AAAs were detected on screening, 23% after 2007, with no significant change per year (p=0.1981). Patients with incidentally detected AAAs were older, had larger AAAs, more likely female and to present with rupture, but had similar incidence of progression to and type of repair (Figure 1). Median follow-up was 18 years. Overall survival in AAA patients was 94%, 72% and 34% at 1, 5 and 15 years, significantly lower than age and sex-matched controls throughout the study (median survival 7.5 vs 11.9 years, p <0.001). Cause of death was unknown in 5.6% patients. Cumulative probability of AAA related death at 10 years was 7.3%, with a 5-fold decrease from the 1st to last decade of the study, (p<0.001). On multivariable regression, older age (HR 3.1), higher Charlson index >7 (HR 2.9) and incidental detection (HR 1.5) were associated with higher risk of overall mortality (p<.001). Median age at diagnosis was higher in women (81 vs 74 years, p<0.001); age adjusted survival was similar to men, (HR=0.93, p =0.26). Conclusions: Incidence of ruptured AAAs and aortic related mortality have decreased significantly in the population over time. Aneurysms are diagnosed and repaired in women almost a decade later than men, with similar age adjusted mortality.



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