Introduction: The incidence of and mortality due to abdominal aortic aneurysm (AAA) have experienced an epidemiological transition in Western countries with reports of decreasing rates from several countries. However, the evidence available from Mediterranean countries, where national AAA screening is not throughout implemented, is insufficient. The aim of this study was to evaluate trends in incidence and mortality after repair due to intact AAA (iAAA) in a Mediterranean country. Methods: iAAA repairs registered in the hospital-based National Health Service database from 2000 to 2015 were analyzed regarding demographics (age and gender) and type of repair (open surgery [OS] or endovascular repair [EVAR]). Incidence and mortality were compared among three time periods: 2000-2004, 2005-2009 and 2010-2015. To adjust for multiple testing due to subgroup analysis p < 0.01 was considered significant. Results: Incidence of iAAA repair increased consistently across the time periods under analysis from 4.2±0.7/100,000/year in 2000-2004, to 6.7±0.5/100,000/year in 2005-2009 and to 8.6±1.0/100,000/year in 2010-2015 (p< 0.001). The increasing incidence of iAAA repair was verified in both gender subgroups being significant in men (p< 0.001) but not in women (p=0.024). The rise in the incidence of iAAA repair was present in both age-bands < 75 and ≥ 75 years-old, being more evident in the last one (6.0±1.3/100,000/year in 2000-2004, 11.6±1.2/100,000/year in 2005-2009 and 15.0±1.1/100,000/year in 2010-2015 (p< 0.001) (Table 1). The percentage of EVAR among all iAAA repairs rose steeply from 0 to 21±19% and then to 58±7% (p< 0.001). The incidence of OS also increased from the first to the second period, but there was a decrease in the third period (p< 0.001). In hospital mortality after iAAA repair decreased from 7.5±1.3% to 6.6±1.6% and then to 5.1±1.9% (p< 0.001) (Table 2). This variation corresponded to a decrease in hospital mortality after EVAR (from 4.0±3.5% to 2.8±0.9%, p< 0.001) and an increased hospital mortality after OS (7.5±1.3% to 7.4±1.1% to 8.3±3.7%, p< 0.001) (Figure 1). Low-volume centres (< 15 repairs/year) did not present higher mortality rates. The number of EVARs per year in a center presented a positive association with EVAR mortality (Spearman correlation of 0.696, p=0.004) (Figure 2). Conclusion: In this Mediterranean country, the incidence of repair of iAAA continues to grow, especially in patients ≥ 75 years-old, and did not reach a break-point yet. These figures lag behind those described in other European countries but a catching up effect is noticeable. This is happening along with decreased repair mortality mainly due to the increased use of EVAR. Notwithstanding, centres with a higher number of EVARs per year presented an unexpected positive association with EVAR mortality, possibly due to broader case selection for EVAR. Hospital mortality for iAAA repair is still a matter of concern, warranting further investigation and planning of vascular surgical services.Figure 2Correlation between the rate of EVAR per year in a center and EVAR mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Table 1Percentage of hospital mortality among different types of intact AAA repair of over time. Legend: yo - years-old, SD - standard deviationTime periods / (Cases/year, n)2000-2015 (249)2000-2004 (143)2005-2009 (245)2010-2015 (342)pEVAR, n (%)1462 (36.6)-270 (22.0)1192 (58.1)<0.001≥ 75, n (%)1574217 (30.0)483 (39.4)874 (42.6)<0.001All repairs, rate per 100,000/y, mean (SD)6.63 (2.03)4.19 (0.73)6.69 (0.53)8.60 (1.01)<0.001EVAR, rate per 100,000/y, mean (SD)2.33 (2.39)-1.45 (1.41)5.00 (0.89)<0.001OS, rate per 100,000/y, mean (SD)4.30 (1.04)4.19 (0.73)5.24 (0.96)3.61 (0.77)<0.001Men, rate per 100,000/y, mean (SD)13.86 (4.26)8.83 (1.52)13.88 (1.07)18.05 (2.29)<0.001Women, rate per 100,000/y, mean (SD)0.81 (0.31)0.45 (0.19)0.91 (0.21)1.02 (0.17)0.024< 75 yo, rate per 100,000/y, mean (SD)5.24 (1.40)3.69 (0.57)5.25 (0.38)6.53 (1.03)<0.001≥ 75 yo, rate per 100,000/y, mean (SD)11.13 (4.01)6.02 (1.29)11.61 (1.24)15.00 (1.14)<0.001 Open table in a new tab Table 2Mortality rate referring to patients discharged as death after repair of intact AAA (iAAA) across three time periodsTime periods / (Deaths/year, n)2000-2015 (14)2000-2004 (11)2005-2009 (16)2010-2015 (17)pAll repairs, rate per 100,000/y, mean (SD)0.39 (0.10)0.31 (0.05)0.44 (0.09)0.42 (0.11)<0.001EVAR, rate per 100,000/y, mean (SD)0.07 (0.07)-0.05 (0.04)0.13 (0.03)<0.001OS, rate per 100,000/y, mean (SD)0.33 (0.10)0.31 (0.05)0.39 (0.12)0.29 (0.10)<0.001Men, rate per 100,000/y, mean (SD)0.79 (0.21)0.63 (0.07)0.87 (0.17)0.85 (0.27)<0.001Women, rate per 100,000/y, mean (SD)0.07 (0.04)0.05 (0.04)0.09 (0.04)0.08 (0.04)0.218< 75 yo, rate per 100,000/y, mean (SD)0.26 (0.06)0.25 (0.06)0.29 (0.09)0.26 (0.03)0.019≥ 75 yo, rate per 100,000/y, mean (SD)0.82 (0.41)0.55 (0.26)0.95 (0.40)0.94 (0.48)0.001 Open table in a new tab Disclosure: Nothing to disclose