Two decades of abdominal aortic aneurysm repair in the Nordic countries from 1998 to 2017: A population-based registry analysis

BACKGROUND AND AIMS: Over recent decades, the management of abdominal aortic aneurysms (AAAs) has undergone substantial transformation, influenced by the introduction of minimally invasive endovascular aneurysm repair (EVAR), advances in early detection, a reduction in disease prevalence, and aging. This study investigated long-term trends in AAA repair incidence, treatment modality, and mortality outcomes across Denmark, Finland, Norway, and Sweden-four neighboring countries with comparable healthcare systems and registry infrastructures. METHODS: National registry data were used to identify intact (iAAA) and ruptured abdominal aortic aneurysm (rAAA) repairs from 1998 to 2017 (2008-2017 for Norway). Repair incidence, treatment modality (EVAR vs open repair (OAR)), and mortality (30-day and 1-year) were calculated and compared by country, age group, sex, and time period. Life-table analyses assessed long-term survival. RESULTS: We identified 39,683 iAAA and 15,086 rAAA repairs. During the study, iAAA repair incidence rose markedly among octogenarians, while rAAA repair incidence declined across all countries. EVAR usage increased over time for both iAAA (11.0%-54.1%) and rAAA (2.5%-24.3%). Perioperative mortality declined throughout the study, with 30-day mortality after iAAA repair falling to 1.9% and after rAAA repair to 27.3%. One‑year mortality similarly improved: for iAAA, it reached 5.9%, and for rAAA, it reached 35.8%. Women had consistently higher 30-day and 1-year mortality than men across all procedure types. Outcomes and survival trends were largely similar between the four countries. CONCLUSION: In the Nordic countries, rAAA repair incidence decreased substantially between 1998 and 2017. EVAR adoption increased and was associated with a rising incidence of iAAA repair in octogenarians. Mortality rates were comparable across the four countries and declined over time for both iAAA and rAAA repair. However, females had consistently poorer perioperative survival than males.