Back to Annual Meeting Program

Objective: Percutaneous endovascular aneurysm repair (PEVAR) has been associated with less groin wound complications and shorter operation times, but same day discharge (SDD) has not been reported. We have been performing PEVAR (Preclose/Proglide technique) since 2005, and noted that all early failures occurred and were addressed in the operating room, with no further events overnight. The goal of our paper is to report the feasibility and safety of ambulatory PEVAR in selected patients.
Methods: Consecutive patients who underwent elective EVAR between March 2011-July 2012 were reviewed. Patients who were functionally independent, without significant comorbidities, and favorable anatomy for PEVAR were given the option to be discharged the evening of the PEVAR after 6 hours of bedrest, if procedure was uneventful. Causes for discharge delay and early outcomes were analyzed.
Results: During the study period, 58 patients underwent AAA repair, and 46 patients (mean age 71.0±10.4,59-97) had elective EVAR (Exclusions: one rupture, 5 acute presentation, 2 fenestrated EVAR, 4 open AAA
repair). 37(77%) had bilateral percutaneous, 6 had unilateral percutaneous, remaining had bilateral endarterectomy. Percutaneous success rate was 98% (2 conversions for inadequate hemostasis). Mean LOS was 1.4±1.5 days (median 1 day) with no 30-day mortality or readmission. Fourteen patients (30%) were discharged the same day, 17 (37%) on POD#1, 12 (26%) on POD#2/3, and 3 (7%) stayed ≥4 days. There were no groin complications. Of the 17 patients who were discharged on POD#1 (instead of same day), 10 were due to significant COPD, CAD, or advanced age, 3 transportation issues, 2 inability to void, and 2 patient preference. Patients in SDD group were significantly younger (66.4±5.6 vs. 73.1±11.3, P=0.041), had smaller AAA (5.2±0.6cm vs. 5.8±1.0, P=0.07), less blood loss (126±103cc vs. 253±209, P=0.037), OR time (80±26 min vs. 143±106, P=0.036). There were less ASA 4 patients in SDD group (21% vs. 44%, P=0.139). Majority of patients had general anesthesia in SDD group (79% vs. 72% for the rest, P=0.634)
Conclusions: Ambulatory PEVAR is feasible and safe in 30% of patients
undergoing elective EVAR, who do not have excessive medical risk, have good functional capacity, and undergo an uneventful procedure. If the hospital reimbursement issues can be resolved, decreasing the LOS would potentially improve cost effectiveness of EVAR.