Outcomes and Cost Comparison of Percutaneous Endovascular Aortic Repair versus Endovascular Aortic Repair With Open Femoral Exposure

Thurston, Jacob S.; Camara, A; Alcasid, Nathan; White, Sarah B.; Patel, Parag J.; Rossi, Peter J.; Hieb, Robert A.; Lee, Cheong

doi:10.1016/j.jss.2019.02.011

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…In pooled analysis of other specific complications, pEVAR was associated with a reduced risk of lymphorrhea/ seroma [11][12][13][14][15][16][20][21] compared to cEVAR (OR = 0.15, 95% CI 0.06 to -0.39, p = 0.0001). However, there were no significant differences between pEVAR and cEVAR with respect to postoperative hematoma [11][12][14][15][17][18]22,23 (OR = 0.81; 95% CI 0.49 to 1.3, p = 0.42), dissection 12,14,16,17,21,23 (OR = 0.54, 95% CI: 0.16 to 1.79, p = 0.31), femoral arterial thrombosis [11][12][13][14][15]17,[21][22] (OR = 1, 95% CI: 0.44 to 2.28, p = 0.87), nerve injury 12,14,20,21 (OR = 0.31, 95% CI: 0.09 to -1.31, p = 0.08), and access site infection 12,15,17,18,[20][21][22][23] (OR = 0.39, 95% CI: 0.14-1.07, p = 0.07).…”

Section: Effects Of Interventionsmentioning

confidence: 82%

“…Following a detailed evaluation of full texts, 12 articles were excluded because they were non-controlled or did not report main results (n = 10) and they were based on the same trial (n = 2). 9-10 A total of 13 studies [11][12][13][14][15][16][17][18][19][20][21][22][23] were eligible for the metaanalysis. The study selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…In our meta-analysis, ultrasound guidance was carried out in two studies, which had high success rates. 12,18 Second, obesity and arterial calcification can also affect the success rate; previous studies have reported that obesity and severe arterial calcification are the major reasons for hemostasis failure. 29 In our meta-analysis, six studies excluded patients with severe arterial calcification and obesity, 11,12,[14][15][16][17] and two studies analyzed femoral arterial calcification and obesity as risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis

Wang

Xiong

et al. 2021

Vascular

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Objective The objective is to investigate whether percutaneous access (pEVAR) is superior to cutdown access (cEVAR) in terms of safety and efficacy during endovascular repair of abdominal aortic aneurysms (AAAs). Methods We searched PubMed, Embase, and Cochrane Library from January 1999 to December 2020 for studies reporting on the comparison between percutaneous and cutdown techniques for endovascular repair of AAAs. Outcomes evaluated were technical success rates, access site-related complications and operative time, and hospital stay. Results Four randomized controlled trials and nine observational studies with a total of 1683 patients comprising 2715 groin accesses were eligible for the meta-analysis. pEVAR was associated with a lower risk of overall complications (odds ratio (OR) = 0.63; p = .005) and seroma/lymphorrhea (OR, 0.18; p = .0001) and shortened operation time (MD = −39.04; p = .002) and the length of hospital stay (MD = −0.75; p < .00001) compared with cEVAR. The technical success rate for pEVAR was 95.1% (694/729), with an overall OR of 0.27 (95% CI 0.14–0.55, p = .0003) comparing pEVAR with cEVAR. Furthermore, pEVAR did not increase the risk of site infection, femoral artery thrombosis, postoperative hematoma, nerve injury, dissection, and bleeding. Conclusion Percutaneous endovascular aneurysm repair is a safe and effective method for the treatment of AAA. It reduces the risk of overall complications and shortens the operation time and hospital stay. The technical success rate of pEVAR is lower than that of cEVAR, which may be linked to the selection of patients, operator experience, and the use of ultrasound. Large definitive trials are required to draw robust conclusions.

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Section: Effects Of Interventionsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis

Wang

Xiong

et al. 2021

Vascular

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“…8 Other singleinstitution and national database studies have confirmed that percutaneous access is associated with a shorter LOS than open access. 8,15,18 Although our study did not perform a cost analysis, this decreased LOS for percutaneous access can be significant in the current value-based health care model.…”

Section: Discussionmentioning

confidence: 89%

Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does Not Affect Major Morbidity or Mortality

Cheng

Maithel

Kabutey

et al. 2021

Annals of Vascular Surgery

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“…Thus moving from EVAR with open surgical femoral exposure to percutaneous radiological femoral access was shown to reduce operating theatre time by 19%, length of stay by 50% and overall cost by 23%. 77 The Audit Commission noted in 1990 that switching to day-case surgery nationwide would allow up to 200,000 patients more to be treated annually without extra expenditure, 78 and similar calculations would show significant cost savings from increased use of IR. Furthermore, in the current COVID era, many IR units have been able to continue doing day-case and outpatient treatments without cancellations due to ward or critical care shortages, 79 also helping to reduce waiting lists, which have recently risen sharply.…”

Section: Cost Effectiveness In Irmentioning

confidence: 99%

Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology

Maudgil

2021

Clinical Radiology

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Healthcare expenditure is continually increasing and projected to accelerate in the future, with an increasing proportion being spent on interventional radiology. The role of cost effectiveness studies in ensuring the best allocation of resources is discussed, and the role of National Institute of Health and Care Excellence (NICE) in determining this. Issues with demonstrating cost effectiveness have been discussed, and it has been found that there is significant scope for improving cost effectiveness, with suggestions made for how this can be achieved. In this way, more patients can benefit from better treatment given limited healthcare budgets.

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Outcomes and Cost Comparison of Percutaneous Endovascular Aortic Repair versus Endovascular Aortic Repair With Open Femoral Exposure

Cited by 11 publications

References 15 publications

Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis

Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis

Access Type for Endovascular Repair in Ruptured Abdominal Aortic Aneurysms Does Not Affect Major Morbidity or Mortality

Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology

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