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Moderate Annual Case Volumes For Treating Abdominal Aortic Aneurysms Is Not A Predictor Of Poor Clinical Outcomes If Adherence To Appropriate Use Criteria And Clinical Practice Guidelines Are Achieved.
Shourya Verma1, Nicholas Fiztpatrick
2, Mark A. Mattos
2.
1Michigan State University College of Human Medicine, East Lansing, MI, USA,
2Michigan Vascular Center, Flint, MI, USA.
Objective:Controversy surrounds whether vascular surgical practices with moderate (<40) annual endovascular (EVAR) or open (OPEN) repair of abdominal aortic aneurysms (AAA) have worse outcomes compared to centers with higher volumes for AAA repairs. We sought to evaluate the outcomes of patients undergoing elective repair of AAAs in our community-based vascular surgery practice which performs a moderate annual volume of AAA repairs. We wished to determine whether adherence to Society for Vascular Surgery (SVS) Appropriate Use Criteria (AUC) for the treatment of AAAs resulted in outcomes as recommended by the SVS Clinical Practice Guidelines (CPG.
Methods:This is a retrospective cohort study of 340 patients (281 male, 59 female) who underwent elective EVAR or OPEN AAA repair from 2014-2020. Patient charts were evaluated for risk factors, comorbidities, aneurysm size, procedure type, thirty-day, one-, three and five-year complications, and survival outcomes following AAA repair.
Results:All patients were operated upon within SVS AUC for AAA repair. 271 patients underwent EVAR (79.7%) and 69 underwent OPEN (20.3%) repair. Conversion to OPEN repair occurred in one patient (0.37%). Conversion from percutaneous groin access to open groin access occurred in 8 arteries (1.5%). Thirty-day mortality was significantly lower for EVAR compared to OPEN [0.7% vs 4.4%, odds ratio: 0.11 (CI:0.0195 to 0.6082), p= 0.0115]. Thirty-day readmission rates were similar for EVAR and OPEN [9.6% vs 6.0% odds ratio 2.02 (CI: 0.7642 to 5.3602), p=0.1559]. One-year survival was significantly greater for EVAR patients [95.6% vs. 86.6%, odds ratio: 0.2986(CI: 0.1202 to 0.7418), p=0.0092]. Long-term 3-year and 5-year survival was not significantly different between the EVAR and OPEN groups 87.1% vs. 83.0%, odds ratio (0.6933 to 2.9066, p= 0.3380] and 80.4% vs. 79.7%, odds ratio (0.4941 to 1.8462, p=0.8914], respectively.
Conclusions:Using appropriate use criteria, our community-based vascular surgical practice with a moderate annual volume of AAA repairs provided similar safe and effective care out to 5 years after EVAR and OPEN AAA repair. Furthermore, we recommend all vascular surgical practices adhere to the SVS Appropriate Use Criteria for AAA repair and continually benchmark their outcomes against published clinical practice guidelines and national recommendations to achieve acceptable short and long-term survival outcomes following elective treatment of abdominal aortic aneurysms.
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