Variations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries.
Cast your vote
You can rate an item by clicking the amount of stars they wish to award to this item.
When enough users have cast their vote on this item, the average rating will also be shown.
Your vote was cast
Thank you for your feedback
Thank you for your feedback
AuthorsBeck, Adam W
Cronenwett, Jack L
MetadataShow full item record
CitationVariations in Abdominal Aortic Aneurysm Care: A Report From the International Consortium of Vascular Registries. 2016, 134 (24):1948-1958 Circulation
AbstractThis project by the ICVR (International Consortium of Vascular Registries), a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.
Registry data for open and endovascular AAA repair (EVAR) during 2010 to 2013 were collected from 11 countries. Variations in patient selection and treatment were compared across countries and across centers within countries.
Among 51 153 patients, 86% were treated for intact AAA (iAAA) and 14% for ruptured AAA. Women constituted 18% of the entire cohort (range, 12% in Switzerland-21% in the United States; P<0.01). Intact AAAs were repaired at diameters smaller than recommended by guidelines in 31% of men (<5.5 cm; range, 6% in Iceland-41% in Germany; P<0.01) and 12% of women with iAAA (<5 cm; range, 0% in Iceland-16% in the United States; P<0.01). Overall, use of EVAR for iAAA varied from 28% in Hungary to 79% in the United States (P<0.01) and for ruptured AAA from 5% in Denmark to 52% in the United States (P<0.01). In addition to the between-country variations, significant variations were present between centers in each country in terms of EVAR use and rate of small AAA repair. Countries that more frequently treated small AAAs tended to use EVAR more frequently (trend: correlation coefficient, 0.51; P=0.14). Octogenarians made up 23% of all patients, ranging from 12% in Hungary to 29% in Australia (P<0.01). In countries with a fee-for-service reimbursement system (Australia, Germany, Switzerland, and the United States), the proportions of small AAA (33%) and octogenarians undergoing iAAA repair (25%) were higher compared with countries with a population-based reimbursement model (small AAA repair, 16%; octogenarians, 18%; P<0.01). In general, center-level variation within countries in the management of AAA was as important as variation between countries.
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. ICVR provides an opportunity to study treatment variation across countries and to encourage optimal practice by sharing these results.
- Editor's Choice - Assessment of Correlation Between Mean Size of Infrarenal Abdominal Aortic Aneurysm at Time of Intact Repair Against Repair and Rupture Rate in Nine Countries.
- Authors: Grima MJ, Behrendt CA, Vidal-Diez A, Altreuther M, Björck M, Boyle JR, Eldrup N, Karthikesalingam A, Khashram M, Loftus I, Schermerhorn M, Setacci C, Szeberin Z, Debus S, Venermo M, Holt P, Mani K
- Issue date: 2020 Jun
- Variation in the elective management of small abdominal aortic aneurysms and physician practice patterns.
- Authors: Davis FM, Jerzal E, Albright J, Kazmers A, Monsour A, Bove P, Henke PK
- Issue date: 2019 Oct
- Regional variation exists in patient selection and treatment of abdominal aortic aneurysms.
- Authors: Zettervall SL, Buck DB, Soden PA, Cronenwett JL, Goodney PP, Eslami MH, Lee JT, Schermerhorn ML, Society for Vascular Surgery Vascular Quality Initiative.
- Issue date: 2016 Oct
- Editor's Choice - Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload.
- Authors: Lilja F, Mani K, Wanhainen A
- Issue date: 2017 Jun
- Editor's Choice - Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years.
- Authors: Budtz-Lilly J, Venermo M, Debus S, Behrendt CA, Altreuther M, Beiles B, Szeberin Z, Eldrup N, Danielsson G, Thomson I, Wigger P, Björck M, Loftus I, Mani K
- Issue date: 2017 Jul