Longitudinal Outcomes After Endovascular Repair of Abdominal Aortic Aneurysms

Abstract

Objective: Endovascular abdominal aneurysm repair (EVAR) is increasingly used, but there is insufficient evaluation of long-term outcomes. Method: Retrospective cohort study using the linked Washington State hospital discharge database. Result: 3,350 patients underwent elective repair of AAA (1181 EVAR) between 2000 and 2005. EVAR patients were older and had higher comorbidity scores. The 30-day readmission rate after EVAR was 11.6%. The 30-day readmissions included cardiac complications (18.5%) and device complications (10.4%). 46% of the 30-day readmissions after EVAR underwent procedures: abdominal/ iliac angiography (7.4%), angioplasty (8.9%), and device revision (8.2%). Mean time to late interventions was 611 days. Conclusion: Readmission, reintervention, and complication rates after EVAR occur more commonly than previously described. Cardiac complications were the most common readmission. Almost half of the 30-day readmissions required a secondary intervention. Long-term complications after EVAR occurred before two years. Population-based assessment may be more reflective of “real world” complication rates after EVAR.

Keywords

abdominal aortic aneurysm endovascular repair outcomes complications

Get full access to this article

View all access options for this article.

References

Wilt TJ , Lederle FA , Macdonald R. , Jonk YC , Rector TS , Kane RL Comparison of endovascular and open surgical repairs for abdominal aortic aneurysm. Evid Rep Technol Assess (Full Rep). 2006;August(144):1-113.

Zarins CK , Heikkinen MA , Lee ES , Alsac JM , Arko FR

Short- and long-term outcome following endovascular aneurysm repair. How does it compare to open surgery?

J Cardiovasc Surg (Torino) . 2004;45:321-333.

EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 365:2179-2186.

EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365:2187-2192.

Greenhalgh RM , Brown LC , Kwong GP , Powell JT , Thompson SG Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364:843-848.

Prinssen M. , Verhoeven EL , Buth J. , et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351: 1607-1618.

Brewster DC , Jones JE , Chung TK , et al. Long-term outcomes after endovascular abdominal aortic aneurysm repair: the first decade. Ann Surg. 2006;244:426-438.

Brown LC , Greenhalgh RM , Kwong GP , Powell JT , Thompson SG , Wyatt MG Secondary interventions and mortality following endovascular aortic aneurysm repair: device-specific results from the UK EVAR trials. Eur J Vasc Endovasc Surg. 2007;34:281-290.

Peterson BG , Matsumura JS , Brewster DC , Makaroun MS Five-year report of a multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysms. J Vasc Surg. 2007;45:885-890.

10.

Deyo RA , Cherkin DC , Ciol MA Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613-619.

11.

Rutherford RB Randomized EVAR trials and advent of level i evidence: a paradigm shift in management of large abdominal aortic aneurysms ? Semin Vasc Surg. 2006;19:69-74.

12.

Anderson PL , Arons RR , Moskowitz AJ , et al. A statewide experience with endovascular abdominal aortic aneurysm repair: rapid diffusion with excellent early results . J Vasc Surg. 2004;39:10-19.

13.

Longo GM , Eskandari MK Overview of success of EVAR: progress to date. Semin Vasc Surg. 2004;17:307-313.

14.

Vogel TR , Nackman GB , Crowley JG , et al. Factors impacting functional health and resource utilization following abdominal aortic aneurysm repair by open and endovascular techniques . Ann Vasc Surg. 2005;19:641-647.

15.

Conrad MF , Crawford RS , Pedraza JD , et al. Long-term durability of open abdominal aortic aneurysm repair . J Vasc Surg. 2007;46:669-675.

16.

Shahian DM , Silverstein T. , Lovett AF , Wolf RE , Normand SL Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards. Circulation. 2007;115:1518-1527.

17.

Bach PB , Guadagnoli E. , Schrag D. , Schussler N. , Warren JL Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care. 2002;40(8 Suppl): IV-19-25.

18.

Warren JL , Klabunde CN , Schrag D. , Bach PB , Riley GF Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care. 2002;40(8 Suppl):IV-3-18.