LAUSR

The study by Yei and coauthors 1 describes 6-year results of abdominal aortic aneurysm (AAA) repair performed via open aneurysm repair (OAR) vs endovascular aneurysm repair (EVAR) using the Vascular Quality Initiative (VQI) Vascular Implant Surveillance and Interventional Outcomes Network (VISION) registry, a multicenter registry that collects granular clinical data on the patients and procedures and links it with Medicare claims for long-term follow up. Among a cohort of more than 32000 patients, Yei et al 1 determined that despite an increased perioperative mortality associated with OAR compared with EVAR, patients treated with OAR experienced superior long-term outcomes. Specifically, patients who underwent OAR, compared with propensity score–matched patients who underwent EVAR, had decreased 6-year mortality (548 deaths [35.6%] vs 608 deaths [41.2%]; hazard ratio [HR], 0.83; 95% CI, 0.74-0.94; P = .002), were less likely to experience late AAA rupture after their index repair (117 participants [5.8%] vs 149 participants [8.3%]; HR, 0.76; 95% CI, 0.60-0.97; P < .001), and were less likely to require reinterventions (additional procedures after the initial repair to treat their AAA) (190 participants [11.6%] vs 267 participants [16.0%]; HR, 0.67; 95% CI, 0.55-0.80; P < .001). These important findings highlight the need for studying both clinical results after AAA repair and long-term surveillance among patients who undergo EVAR.