Patients undergoing placement of hemodialysis access are at high risk for readmission mostly from causes unrelated to their operation. This has an effect for global care for these patients as well as care of these patients in accountable care organizations.

months after randomization) mortality was lower in the EVAR groups (46 of 1393 vs 73 of 1390 deaths; P ¼ .010), primarily because the 30-day operative mortality was lower in the EVAR groups (16 deaths vs 40 for open repair). Later (#3 years), the survival curves converged and remained so to 8 years with a nonsignificant shift of the hazard ratio in favor of open repair. At 5 years, the estimated survival rate was 73.6% in both groups. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths vs 3 for open repair; P ¼ .010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage with EVAR. None of the morphologic aneurysm characteristics, smoking, diabetes, basal metabolic index, age, or gender was associated with mortality. Those with peripheral artery disease (ABI <0.9) had lower mortality under open repair (39 vs 62 deaths; P ¼ .022) in the period from 6 months to 4 years after randomization. The overall rates of reintervention were higher in the EVAR group (range, 5.1%-8.5%) than the open group (range, 1.9%-4.6%). The commonest complications after EVAR was a type II endoleak (325 patients [11.7%]), with correction deemed necessary in 22.8%. The second most common was a type I endoleak (120 [4.3%]) and received early intervention in 65.8%. For those 37 patients with reported sac rupture, the median time to rupture was 3.5 years. All but 19 had a known graft endoleak or migration before rupture, of which approximately two-thirds had been addressed. The 30-day mortality with rupture was 62%.Comments: This meta-analysis confirms the fact that EVAR is not the definitive repair that an open operation provides. It may well benefit those with a limited life expectancy such as the elderly and others who are less able to weather the stresses of an open operation. In some patients (significant renal impairment and coronary artery disease), EVAR may not even provide an early mortality advantage. In addition, an open operation may well be the best therapy for the young and healthy. No matter, if you chose to treat a patient with an abdominal aortic aneurysm with EVAR, surveillance is critical to reduce aneurysmrelated deaths in the mid-and long-term. This may change with improved devices, but for now, this is the crucial clinical message.

Causes for readmission of vascular surgery patients are multifactorial. Infections, both related and unrelated to the surgical site, remain common reasons for readmission and represent an opportunity for improvement strategies. Improved understanding of readmissions following vascular surgery could help adjust policy benchmarks for targeted readmission rates and help reduce resource utilization.