Editor's Choice – Optimal Threshold for the Volume–Outcome Relationship After Open AAA Repair in the Endovascular Era: Analysis of the International Consortium of Vascular Registries

Abstract

In this study by the International Consortium of Vascular Registries, the optimal open abdominal aortic aneurysm (AAA) repair centre volume threshold that is associated with the most significant mortality risk reduction was examined. When assessing open aortic procedures in 11 countries, 13 e 16 procedures/year predicted the most significant reduction in mortality after intact AAA repair. Only 23% of centres met the ! 13 procedures/ year volume threshold. Although open AAA repair preferentially should be performed at centres achieving this target volume threshold, significant re-organisation of aortic care services in several nations is required.

Incidence, predictive factors, and outcomes of intraprocedure adverse events during fenestrated-branched endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms

“…Similar to other complex operations (eg, esophagectomy, pancreatectomy, open TAAA repair, etc), outcomes of FB-EVAR are dependent on surgeon and center experience. 5,25,26 Cochennec and colleagues reported an incidence of IAEs of 30% during FB-EVAR. In that study, TA complications occurred in 19% of patients, including access-related complications in 9% and graftrelated complications in 4%.…”

Endovascular versus open repair in patients with abdominal aortic aneurysm: a claims-based data analysis in Japan

“…Historically, highly coordinated cooperative efforts of vascular surgeons, such as the VASCUNET and the VQI, have helped develop evidence-based guidelines to improve the outcomes of patients with AAA 38. In addition, the Medical Device Epidemiology Network (MDEpiNet), a public-private partnership supported by the US FDA, has established the ICVR 39–41. Japanese surgeons also contributed to internationally coordinated registry networks 42.…”

Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms: Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes

“…More than 154,000 patients underwent OSR and EVAR for intact AAA were analyzed by Scali and colleagues to identify an optimal center volume associated with the most significant mortality reduction after OSR; 65,745 underwent OSR and a significant inverse relationship between increasing center volume and lower peri-operative mortality after intact and ruptured OAR was evident ( p < 0.001). An annual center volume of between 13 and 16 procedures per year (PY) was associated with the most significant mortality reduction after intact OAR (adjusted predicted mortality <13 PY 4.6% vs. 3.1% for centers with ≥13 PY) [ 29 ]. Data from a recent nationwide mandatory quality registry showed similar results for 694 patients, treated by FEVAR (539) and BEVAR (155).…”