To compare rates of mortality, rupture and secondary intervention following endovascular
repair (EVAR) of intact abdominal aortic aneurysms (AAA) using contemporary endograft
devices from three major manufacturers.
Retrospective cohort study using linked clinical registry (Australasian Vascular Audit)
and all payer administrative data.
We identified patients undergoing EVAR for intact AAA between 2010-2019 in New South
Wales, Australia. We compared rates of all-cause mortality, secondary rupture and
secondary intervention (subsequent aneurysm repair; other secondary aortic intervention)
for patients treated with Cook, Medtronic and Gore standard devices. We used inverse
probability of treatment weighted proportional hazards and competing risk regression
to adjust for patient, clinical and aneurysm characteristics, using Cook as the referent
We identified 2,874 eligible EVAR patients, with a median follow-up of 4.1 (maximum
9.5) years. Mortality rates were similar for patients receiving different devices
(ranging between 7.0-7.3 per 100 person-years). There was no significant difference
between devices in secondary rupture rates, which ranged between 0.4-0.5 per 100 person-years.
Patients receiving Medtronic and Gore devices tended to have higher crude rates of
subsequent aneurysm repair (1.5 per 100 person-years) than patients receiving Cook
devices (0.8 per 100 person-years). This finding remained in the adjusted analysis,
but was only statistically significant for Medtronic devices (HR 1.57, 95% CI 1.02-2.47;
HR 1.73, 95% CI 0.94-3.18 respectively).
Major endograft devices have similar overall long-term safety profiles. However, there
may be differences in rates of secondary intervention for some devices. This may reflect
endograft durability, or patient selection for different devices based on aneurysm
anatomy. Continuous comparative assessments are needed to guide evidence for treatment
decisions across the range of available devices.