National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients

Abstract

The number of open AAA repairs fell by nearly 80% during the last decade, whereas traditional EVAR declined slightly and branched-fenestrated EVAR rapidly disseminated into national practice. These results suggest that open AAA repair is now performed too infrequently to be used as a metric in the assessment of hospital and surgeon quality in cardiovascular care. Furthermore, surgical training paradigms will need to reflect the changing dynamics necessary to ensure that surgeons and interventionists can safely perform these high-risk surgical procedures.

Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study

“…Also, patients who suffered a myocardial injury required more red blood cell transfusions. Patients with myocardial injury also had a prolonged median [IQR] length of hospital stay than patients without myocardial injury (8 [4][5][6][7][8][9][10][11][12][13][14][15] days vs 5 [4][5][6][7][8][9] days, respectively; P \ 0.001). In multivariate analysis, age, RCRI score C 3, ASA physical status IV, duration of surgery, and perioperative drop in hemoglobin significantly increased the risk of myocardial injury ( Table 3).…”

“…The majority of patients with postoperative AKI (24/25, 96%) met the stage 1 AKIN criteria (i.e., increase in serum creatinine C 27 lmolÁL-1 or C 1.5-fold compared with baseline level) and 4% (1/25) met the stage 3 AKIN criterion for AKI (i.e., increase in serum creatinine [ three-fold compared with baseline level). In general, patients who developed AKI had lower preoperative eGFR, [7][8][9][10][11][12][13][14][15][16][17] days vs 5 [4][5][6][7][8][9][10] days, respectively; P = 0.01). In multivariate analysis, length of surgery and preoperative eGFR were associated with AKI occurrence (Table 4).…”

“…Complications related to AAAs were the underlying cause of almost 10,000 deaths in the United States in 2016 and are ranked by the Centre for Disease Control as one of the top 15 causes of mortality in adults aged C 65 yr. [1][2][3][4] Endovascular aneurysm repair (EVAR) is the current intervention of choice for the management of infrarenal aortic aneurysms because of improved short-term morbidity and mortality outcomes compared with open surgical repair, particularly in high-risk patients with multiple comorbidities. 1,3,5,6 Despite technological advances in stent design and implantation, EVAR is still considered an intermediate-to high-risk procedure in terms of cardiovascular and renal complications. 1,3,6,7 Perioperative myocardial injury and acute kidney injury (AKI) are both independently associated with higher morbidity, 30-day mortality, and prolonged length of hospital stay in patients following noncardiac and vascular surgery.…”

Percutaneous endovascular abdominal aneurysm repair: State‐of‐the art

“…However, high‐risk patients with juxtarenal AAAs may be better served with a fenestrated EVAR compared to the risk of open surgery . Branched endografts have the same concept of visceral perfusion protection with stents preattached to the endograft body . On the other hand, multilayer flow‐diverting stents represent a new concept of aneurysm exclusion with reconstruction of the parent vessel.…”

“…38 Branched endografts have the same concept of visceral perfusion protection with stents preattached to the endograft body. 39 On the other hand, multilayer flow-diverting stents represent a new concept of aneurysm exclusion with reconstruction of the parent vessel. The stagnant blood flow within the aneurysm sac leads to thrombosis and perfusion is maintained to the side branches of the parent vessel.…”