Performance of endovascular aortic aneurysm repair in high-risk patients: Results from the Veterans Affairs National Surgical Quality Improvement Program

Abstract

In veterans deemed high-risk for surgical therapy, outcomes after elective EVAR are excellent, and the procedure is relatively safe in this special patient population. Our retrospective data demonstrate that patients with considerable medical comorbidities and infrarenal abdominal aortic aneurysms benefit from and should be considered for primary EVAR.

Abdominal Aortic Aneurysms: Changing Paradigms in Treatment

“…25 (Swedish study) This prompted a Department of Veteran Affairs analysis citing that "recent results after endovascular abdominal aortic aneurysm repair (EVAR) have brought into question its value in patients deemed at high-risk for surgical intervention." 26 The Department of Veteran Affairs (VA) National Surgical Quality Improvement Program (NSQIP) is the largest prospectively collected and validated United States surgical database representing current clinical practice. Utilizing this database a study was designed to evaluate outcomes after elective EVAR performed in high-risk veterans.…”

“…The primary end points were 30-day and 1-year all-cause mortality. 26 The investigators concluded that veterans deemed high-risk for surgical therapy, outcomes after elective EVAR are excellent, and the procedure is relatively safe in this special patient population. Our retrospective data demonstrate that patients with considerable medical comorbidities and infrarenal abdominal aortic aneurysms benefit from and should be considered for primary 26 EVAR.…”

“…26 The investigators concluded that veterans deemed high-risk for surgical therapy, outcomes after elective EVAR are excellent, and the procedure is relatively safe in this special patient population. Our retrospective data demonstrate that patients with considerable medical comorbidities and infrarenal abdominal aortic aneurysms benefit from and should be considered for primary 26 EVAR. Another American group conducted an interesting study in response the the EVAR-2 publication to determine the outcome in the United States after endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs) in patients at high-risk for open surgery.…”

Evolving Approaches to Thoracoabdominal Aortic Aneurysm Repair: Open Surgical and Endovascular Treatment Using Fenestrated/Branched Endografts

“…6,7 The argument for endovascular TAAA repair comes from the excellent outcomes of patients treated for infrarenal abdominal aortic aneurysm (AAA). [8][9][10] Based on these findings, endovascular TAAA repair using either fenestration or directional branches is increasingly gaining acceptance in the medical community. The Achilles heel of this repair remains the long-term patency of target vessels and the devastating complication of spinal cord ischemia.…”

Manejo del aneurisma de la aorta abdominal: Estado actual, evidencias y perspectivas para el desarrollo de un programa nacional

“…(VA) 17,18 que comparan ambos tratamientos en forma retrospectiva los que, junto a series clínicas provenientes de instituciones individuales, deben ser interpretados en forma cuidadosa, con un nivel de evidencia menor.…”