EVAR Trends Over the Past Decade and Their Impact on Aneurysm Mortality: National Health Insurance Data Analysis

Background/Objectives: There was no report about the nationwide trend of abdominal aortic aneurysm (AAA) repair and mortality rate. This study aims to evaluate the trend of AAA treatment and related mortality, including ruptured AAA (rAAA) and intact AAA (iAAA) over the recent 13 years. Methods: A serial, cross-sectional study with time trends of patients who were treated with AAA and underwent aneurysm repair between 2010 and 2022. Data from the Health Insurance Review and Assessment Service (HIRA) and Statistics Korea were used. A linear-by-linear association and Poisson regression analysis were performed to determine the changes in the treatment of AAA and related mortality. Results: The number of patients with rAAA increased from 462 in 2010 to 770 in 2022 (relative risk, RR 1.57, P<.0001). And the number of patients with iAAA increased from 3,685 to 12,399 in the same period (RR 3.16, P<.0001). Endovascular aneurysm repair (EVAR) has been more commonly performed since 2011. During the study period, EVAR increased from 406 to 1,161 (RR 2.68, P<.0001). Although the annual mortality rates after iAAA treatment decreased from 1.4% to 0.7% (mean mortality rate, 1.1%), those after rAAA treatment were similar from 34.6% to 34.2% during the study period (mean mortality rate, 35.2%). Conclusions: During the recent 13 years, the annual number of patients with rAAA and iAAA increased. Since 2011, EVAR has been more commonly performed. The annual iAAA-related mortality rate decreased along with the increasing trend of EVAR. However, the annual rAAA-related mortality rate did not change.