Institutional Impact of EVAR’s incorporation in the treatment of Abdominal Aortic Aneurysm – A 12 ears experience analysis

Abstract

IntroductionEndovascular aneurysm repair (EVAR) was introduced as a less aggressive treatment of abdominal aortic aneurysms (AAA) for patients ineligible for open repair (OR).ObjectiveTo analyze EVAR's incorporation impact in the treatment of infra-renal abdominal aortic aneurysms in our institution.MethodsA retrospective study of the patients with diagnostic of infra-renal AAA treated between December 2001 and December 2013 was performed. The choice between EVAR and OR was based on surgeon's experience, considering patient clinical risk and aneurysm's anatomical features. Patients treated by EVAR and by OR were analyzed. In each group, patient's and aneurysm's characteristics, surgical and anesthesia times, cost, transfusion rate, intraoperative complications, hospital stay, mortality and re-intervention rates and survival curves were evaluated.ResultsThe mean age, all forms of heart disease and chronic renal failure were more common in EVAR group. Blood transfusion, surgical and anesthesia times and mean hospital stay were higher for OR. Intraoperative complications rate was higher for endovascular aneurysm repair, overall during hospitalization complication rate was higher for open repair. The average cost in endovascular aneurysm repair was 1448.3€ higher. Re-interventions rates within 30 days and late re-intervention were 4.1% and 11.7% for endovascular aneurysm repair versus 13.7% and 10.6% for open repair.ConclusionsTwo different groups were treated by two different techniques. The individualized treatment choice allows to achieve a mortality of 2.7%. Age ≥80 years influences survival curve in OR group and ASA ≥IV in EVAR group. We believe EVAR's incorporation improved the results of OR itself. Patients with more comorbidities were treated by endovascular aneurysm repair, decreasing those excluded from treatment. Late reinterventions were similar for both techniques.

Single-center Study Comparing Short and Mid-Term Results of EVAR in Old and Young Populations

“…Saadi et al [18] reported that the survival rate free from reinterventions is 96% after 27 months without operative or postoperative deaths. In our study, six (7%) patients (one young, five geriatric) underwent secondary intervention procedures (five endovascular, one OSR); in contrast, the literature states that secondary interventions occur in 7-13.3% of patients [13,19] .…”

“…Machado et al [13] reported that age > 80 years influences the survival curve in only OSR group. But in a study by Schermerhorn et al [14] , when the age increased, the survival rate decreased, even in the EVAR group.…”

Real-world cost analysis of endovascular repair versus open repair in patients with nonruptured abdominal aortic aneurysms

“…[12][13][14] The European randomized, controlled trials [15][16][17] aid little with respect to estimating aortic procedure cost owing to the exclusion of possible abdominal complications 18 and late reinterventions after OAR. 18,19 Additionally, there are likely differences between the cost of hospital stay in Europe compared with the cost of hospital stay in the United States. 20 Systematic reviews that conclude that EVAR is more costly also have their shortcomings with respect to estimating contemporary aortic procedure costs, as most of these studies include only the early years of EVAR use.…”