How EVAR Changed the Game: Trends in Patient Characteristics, Surgical Techniques and Outcomes of Non–-ruptured AAA Repair in Germany from 1999 to 2010

Abstract

2. The number of CEAs under loco-regional anesthesia increased significantly from 10.1% to 28.1% (p < 0.0001). Intraluminal shunting was performed less frequent (48.1% to 43.5%, p < 0.0001), whereas an intraoperative morphological control of the carotid artery was performed more often (44.5% to 68.3%, p < 0.0001). Any neuro-monitoring method was used increasingly (CEA: 49.8% to 61.4%, CAS: 33.7% to 35.8%; p < 0.0001). The portion of patients who were neurologically assessed before or after CEA increased from 61.7% to 69.0% and 36.5% to 57.2% respectively. In CAS 78% of the patients were assessed before and 70% after the procedure. The median time interval between the neurological index event and CEA was reduced from 25 in 2003 to 8 days in 2013 (CAS: 9 days in 2012 and 2013). 3. Combined peri-procedural stroke and death rates decreased significantly in asymptomatic patients after CEA (2.0% to 1.3%, p 1⁄4 <0.001) and remained stable for CAS (1.7%). In symptomatic patients with a 50e99% stenosis peri-operative complication rates decreased significantly (4.6% to 2.7%, p 1⁄4 0.001) whereas CAS was associated with a risk of 3.9% in 2012 and 4.2% in 2013. Conclusion: The analysis of the annual quality reports demonstrates that CEA and CAS were performed within acceptable stroke and death rates. While patient age is increasing the clinical outcomes after CEA have improved significantly over time. Most importantly the time interval between the neurological index event and CEA or CAS could be reduced to 8 to 9 days.