Background: Treatment of abdominal aortic aneurysm (AAA) has changed over time, with endovascular repair (EVAR) being the main technical revolution. This study assessed the effect of this change on outcome on a national basis over a 17-year interval.

Methods: Primary infrarenal AAA repairs in Swedish residents aged 50 years and older, in the Swedish Vascular Registry (Swedvasc) 1994-2010, were analysed. The rate per 100,000 population, patient characteristics, operative technique and outcome were assessed for the intervals 1994-1999, 2000-2005 and 2006-2010.

Results: Some 11,336 intact aneurysm repairs were performed. The overall rate per 100,000 increased (18.4 in 1994-1999, 19.4 in 2000-2005 and 24.0 in 2006-2010; P < 0.001), most noticeably among older people (18 per cent increase among those aged 50-64 years, P = 0.004; 27 per cent in 65-79-year-olds, P < 0.001; 128 per cent in those aged at least 80 years, P < 0.001). The use of EVAR increased rapidly after 2005 (rate: 0.6 in 1994-1999, 4.4 in 2000-2005 and 11.8 in 2006-2010; P < 0.001). The 30-day mortality rate decreased after open repair (4.7, 3.4 and 2.7 per cent respectively; P < 0.001), but was stable after EVAR (2.6, 2.2 and 1.6 per cent; P = 0.227). Some 4972 ruptured aneurysm (rAAA) repairs were performed. The rate decreased after 2005 (9.3 in 1993-1999, 9.3 in 2000-2005 and 8·4 in 2006-2010; P = 0.006). The use of EVAR for rAAA increased over time (rate: 0, 0.5 and 1.6 respectively; P < 0.001), whereas open repair decreased (9.3, 8.8 and 6.8; P < 0.001). Thirty-day mortality decreased over time (38.3, 32.8 and 28.4 per cent; P < 0.001).

Conclusions: The introduction of EVAR has been associated with an increased number of intact AAA repairs, which has accelerated recently, whereas the rate of rAAA repair has started to decline. Simultaneously, outcomes have improved.