Ambulatory percutaneous endovascular abdominal aortic aneurysm repair

Döslüoglu, Hasan H.; Lall, Purandath; Blochle, Raphael; Harris, Linda M.; Dryjski, Maciej L.

doi:10.1016/j.jvs.2013.06.076

Cited by 46 publications

(27 citation statements)

References 38 publications

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“…However, our study demonstrates that performing a concomitant procedure is a predictor of percutaneous access failure. A significantly decreased mean total operative time 2–8 and a shorter length of hospital stay 3, 6, 9, 10 were noted in many previous studies in pEVAR patients when compared to cEVAR patients. Prior studies have noted wound complications ranging from 0–11% 9, 14 with a rate of 5.0% 2 noted in the randomized trial.…”

Section: Discussionmentioning

confidence: 52%

“…2 Several small single center studies using a variety of grafts showed a reduction in total operative time 2–8 and length of hospital stay. 3, 6, 9, 10 Additionally, access-related complication rates were lower with pEVAR compared to cEVAR. 2, 4, 6–12 Despite these promising results, the possibility of publication bias should be considered.…”

Section: Introductionmentioning

confidence: 93%

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Percutaneous versus femoral cutdown access for endovascular aneurysm repair

Buck

Karthaus

Soden

et al. 2015

Journal of Vascular Surgery

104

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Objective Prior studies suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (pEVAR) offers significant operative and post-operative benefits compared to femoral cutdown (cEVAR). National data on this topic, however, are limited. We compared patient selection and outcomes for elective pEVAR and cEVAR. Methods We identified all patients undergoing either pEVAR (bilateral percutaneous access whether successful or not) or cEVAR (at least one planned groin cutdown) for abdominal aortic aneurysms (AAA), from January 2011 to December 2013 in the Targeted Vascular dataset from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Emergent cases, ruptures, cases with an iliac conduit, and cases with a preoperative wound infection were excluded. Groups were compared using chi-square test or t-test or the Mann-Whitney test where appropriate. Results 4112 patients undergoing elective EVAR were identified; 3004 cEVAR (73%) and 1108 pEVAR (27%). Of all EVAR patients 26% had bilateral percutaneous access, 1.0% had attempted percutaneous access converted to cutdown (4% of pEVARs), while the remainder had a planned cutdown, 63.9% bilateral, and 9.1% unilateral. There were no significant differences in age, gender, aneurysm diameter or prior open abdominal surgery. Patients undergoing cEVAR were less likely to have congestive heart failure (1.5% vs. 2.4%, P=0.04) but more likely to undergo any concomitant procedure during surgery (32% vs. 26%, P<.01) than patients undergoing pEVAR. Postoperatively, pEVAR patients had shorter operative time (mean 135 vs. 152 minutes, P<.01), shorter length of stay (median 1 day vs. 2 days, P<.01), and fewer wound complications (2.1% vs. 1.0%, P=0.02). On multivariable analysis the only predictor of percutaneous access failure was performance of any concomitant procedure (OR 2.0, 95% CI 1.0–4.0, P=0.04). Conclusions Currently, 1 in 4 patients treated at Targeted Vascular NSQIP centers are getting pEVAR, which is associated with a high success rate, shorter operation time, shorter length of stay, and fewer wound complications compared to cEVAR.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 93%

Percutaneous versus femoral cutdown access for endovascular aneurysm repair

Buck

Karthaus

Soden

et al. 2015

Journal of Vascular Surgery

104

View full text Add to dashboard Cite

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“…3–6 Indeed, advances in arterial access and closure enable EVAR to be safely performed as an entirely percutaneous procedure, often on an outpatient basis. 7–9 As such, EVAR has particular utility in patients with suitable anatomy who are at higher risk for adverse perioperative outcomes, such as the elderly, those with multiple comorbidities, or patients with impaired functional status. 5,10 …”

Section: Introductionmentioning

confidence: 99%

Functional status predicts major complications and death after endovascular repair of abdominal aortic aneurysms

Harris

Bulatao

Oates

et al. 2017

Journal of Vascular Surgery

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Objective Endovascular aortic repair (EVAR) is considered a lower risk option for treating abdominal aortic aneurysms (AAA), and is of particular utility in patients with poor functional status who may be poor candidates for open repair. However, the specific contribution of preoperative functional status EVAR outcomes remains poorly defined. We hypothesized that impaired functional status, based simply on the ability of patients to perform activities of daily living, is associated with worse outcomes after EVAR. Methods Patients undergoing non-emergent EVAR for AAA between 2010 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. The primary outcomes were 30-day mortality and major operative and systemic complications. Secondary outcomes were inpatient length of stay, need for reoperation, and discharge disposition. Using NSQIP defined preoperative functional status, patients were stratified as Independent or Dependent (either partial or totally dependent), and compared by univariate and multivariable analyses. Results Of 13,432 patients undergoing EVAR between 2010 – 2014, 13,043 were independent (97%) and 389 were dependent (3%) prior to surgery. Dependent patients were older and more frequently minorities; had higher rates of chronic pulmonary, heart, and kidney disease; and were more likely to have an American Society of Anesthesiologists score of 4 or 5. On multivariable analysis, preoperative dependent status was an independently risk factor for operative complications (OR 3.1, 95% CI 2.5 – 3.9), systemic complications (2.8, 2.0 – 3.9), and 30-day mortality (3.4, 2.1 – 5.6). Secondary outcomes were worse among dependent patients. Conclusions Although EVAR is a minimally invasive procedure with substantially less physiologic stress than open aortic repair, preoperative functional status is a critical determinant of adverse outcomes after EVAR, in spite of the minimally invasive nature of the procedure. Functional status, as measured by performance of activities of daily living, can be used as a valuable marker of increased perioperative risk, and may identify patients who may benefit from preoperative conditioning and specialized perioperative care.

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“…29 A few centers have even taken this a step further by attempting to perform PEVAR as an ambulatory procedure successfully in ≈30% to 40% of patients. [30][31][32] It is conceivable that with lower-profile devices on the horizon and increased operator comfort with percutaneous closure, the prevalence of PEVAR will continue to rise.…”

Section: Closure Devices For Endovascular Interventionsmentioning

confidence: 99%

“…34 With the use of the aforementioned techniques, the overall success rates of PEVAR were excellent, with most studies quoting an incidence of 90% to 96%. 7,31 One contemporary review of 22 articles that included 1087 patients revealed procedural success in 92% of patients. 43 A larger meta-analysis including 36 articles and 2257 patients (3606 access sites) revealed success in 92% of patients (94% per access site).…”

Section: Closure Devices For Endovascular Interventionsmentioning

confidence: 99%