“Jack Of All Trades, Master Of None”: Should Physicians Concentrate On One Endograft?
Eric J. Maldonado, MD, Gabriella Fluss, PA-C, David J. Finlay, MD, FACS, RPVI.
Metropolitan Hospital Center at New York Medical College, New York, NY, USA.
OBJECTIVES:Many surgeons in community practice spend time and resources learning a variety of endografts. With limited inventory, pre-operative planning can be crucial in the ability to fix an aneurysm properly. We propose that preoperative marker angiogram and mastery of one endograft produces superior results. This study examined a single surgeon's experience exclusively using the Cook Zenith endograft for endovascular AAA repair (EVAR) in a private practice, community setting.METHODS: Data from 79 patients from June 2005 - August 2015 was retrospectively reviewed. Outcomes were measured for overall survival, presence of endoleak, early and late postoperative complications, aneurysm growth, and reintervention.RESULTS:Mean follow-up was 28 months (1-111 months). Mean aneurysm sac size 5.4 cm (3.2 - 9.4 cm). Combined aortic and iliac aneurysms were present in 24%, 2 patients had inflammatory aneurysm and 2 presented with rupture. Mean age 74.47 years, 61 male, 18 females. Medical comorbidities: hypertension in 59%, history smoking 80%. Preoperative marker angiogram performed in 91%. Preoperative hypogastric coil embolization performed in 13%. Mean length of procedure 2 hours 37 minutes. All groin access were open, no percutaneous access. Overall survival 100%. Freedom from reintervention 98.6%. No early postoperative complications, late complications 3% requiring thromboendarterectomy, which remained patent on follow-up. Endoleaks occurred in 32% (all type 2).CONCLUSIONS:There are many endografts on the market and physicians are courted to use newer grafts with minimal long-term data. Results have been linked to the number of cases performed with no continuity of endografts. For this reason, some speculate that EVAR results would improve if left to high-volume centers. We propose that physicians with limited resources, performing smaller volumes of aneurysm repairs, should concentrate on 1 possibly 2 grafts. Additionally, pre-operative angiograms with marker catheters maximize the vendor's ability to provide inventory. Thus, we conclude that excellent results can be obtained in a community setting with good pre-operative planning and mastery of a single endograft.
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