A Propensity Score Matched Analysis Between an Infrarenal Fixation Device With ePTFE (Device A) and Two Suprarenal Fixation Devices With Dacron Fabric (Devices B and C)

OBJECTIVES: Endovascular stent grafts have changed the treatment paradigm of endovascular aneurysm repair (EVAR). This study aims to compare the length of stay and all renal failure rates of an infrarenal fixation device with expanded polytetrafluoroethylene (ePTFE) (Device A) versus two suprarenal fixation devices with Dacron fabric (Device B) and (Device C).

METHODS: An in-depth analysis was undertaken using the Premier healthcare database (PHD), identifying patients who underwent endovascular aortic repair with either Device A, B or C. Propensity score matching was employed to create balanced cohorts for each graft type between Device A (n = 2,626) and Device B (n = 2,626) and between Device A (n = 1,044) and Device C (n = 1,044). This controlled for potential confounders. Length of stay at the index procedure and the occurrence of all renal failure rates at one year were assessed as outcomes of interest.

RESULTS: Following propensity score matching, Device A demonstrated a significantly shorter overall LOS compared to Device B (2.7 days versus 3.2 days) (P < 0.0001) and Device C (2.9 versus 3.6 days) (P < 0.0001), respectively. Furthermore, the incidence of all renal failure rates at one-year follow-up was significantly lower in the Device A group in comparison to the Device B group (21.4% versus 24.3%) (P < 0.015) and versus Device C (23.9% versus 28.4%) (P < 0.022), respectively.

CONCLUSIONS: This study analyzed the PHD for real world comparative outcomes of commercially available stent grafts. Device A exhibited a statistically significant reduced LOS and occurrence of all renal failure at one-year follow-up when compared with Device B and versus Device C. These findings reflect the potential benefits of Device A based on real world evidence with a robust employed matching technique. However, further investigation and consideration are required in clinical decision-making for differing aortic pathologies.