Treatment of AAA differs by country, reimbursement

Editor's Note

Despite guidelines from professional societies, significant variation exists in the management of abdominal aortic aneurysm (AAA), especially for AAA size at repair, use of endovascular aneurysm repair (EVAR), and the treatment of elderly patients, this study finds.

In countries with a private health care system and fee-for-service reimbursement, surgeons more often perform prophylactic surgery in patients early on at smaller aneurysm diameters, which is not recommended by guidelines. Surgeons in these countries also are more likely to offer surgical repair in elderly patients more than 80 years of age and to perform repair with EVAR.

In countries with socialized healthcare, surgeons more often follow the guidelines and wait with repair until the aneurysm reaches the size of 5.5 cm for men and 5.0 cm for women. Access to EVAR is constrained by local regulations and financial disincentives.

Background -This project by the International Consortium of Vascular Registries, a collaboration of 11 vascular surgical quality registries, was designed to evaluate international variation in the contemporary management of abdominal aortic aneurysm (AAA) with relation to recommended treatment guidelines from the Society for Vascular Surgery and the European Society for Vascular Surgery.