RS21 - Deferred AAA Repair in Patients Who Meet Threshold Criteria for Repair

Objectives: The Preferences for Open Versus Endovascular Repair of Abdominal Aortic Aneurysm (PROVE-AAA) is a randomized trial of a novel decision aid to assist Veterans decide between AAA repair options. Over the trial period, a proportion of patients had repair of their aneurysm deferred. We examined the reasons for deferral of AAA repair and associated outcomes and patient characteristics.

Methods: PROVE-AAA is a cluster-randomized trial to test the effect of a decision aid on the alignment of patient preference and repair type for AAA. Enrollment opened in April 2017 and closed in December 2020 for patients with AAA measuring at least 5.0 cm in diameter who were candidates for both open and endovascular repair (EVAR). After meeting with their surgeon, patients either were scheduled for surgery or deferred repair based on shared decision-making with their surgeon. Active surveillance patients were prospectively monitored throughout the study, and we recorded the reasoning for deferring surgery. Survival status was examined using VA’s Corporate Data Warehouse.

Results: The proportion of patients who had AAA repair deferred did not differ based on whether they received a decision aid or underwent standard of care (Pie chart). The reasons for deferring surgery were similar between patients who received a treatment decision aid and patients who underwent routine counseling (control) (Table 1) with the majority of patients still awaiting surgery. The average time since enrollment that patients had repair deferred is 28 months. The mean aneurysm size for the study population was 5.7 cm and did not differ between patients who underwent repair versus those who had surgery deferred (5.7 vs 5.6 cm P=0.20, Range5.0-6.5 cm). Patient characteristics were comparable between patients who deferred repair and those who did not: Age (70 Y for those who deferred and 72 Y who did not), hypertension (90% vs 88%), and diabetes ( 30% vs 33% ). As of December 2021, no aneurysm ruptures have occurred among patients who had AAA repair deferred. Patients’ satisfaction scores were similar between patients who underwent repair and those who deferred repair.

Conclusions: Approximately one in five Veterans with AAA meeting SVS criteria for repair had their repair deferred in this study cohort. None of them incurred aneurysm rupture while remaining under surveillance, and they were similarly satisfied with their decision when compared to those who chose to undergo repair. Surgeons can safely defer AAA repair in patients who meet diameter threshold for repair for a moderate time.