Methodological appraisal of a published single-center experience with fenestrated endovascular aneurysm repair.

The modern open surgical management of abdominal aortic aneurysm (AAA) has changed little since its inception in the 1950s. Endoaneurysmorrhaphy, first described by Rudolph Matas in 1888, involved ligating the branches of an aneurysm from within the aneurysm sac. Approximately 25 years later at the

Introduction: Abdominal aortic aneurysm (AAA) is associated with significant morbidity and mortality. Treatment options include open and endovascular AAA repair. We explored the utilization patterns and outcomes of open and endovascular AAA repair among hospitalized patients in the US. Hypothesis: We hypothesized that there would be no difference in the utilization patterns of open and endovascular AAA repair by race and gender. Methods: Using the ICD-10 diagnosis and procedure codes, we queried the National Inpatient Sample 2016 to 2019 for hospitalizations among patients ≥18 years old who had an open or endovascular AAA repair. Multivariable logistic regression was used to estimate the odds of death and discharge dispositions comparing open to endovascular AAA repair. Regression models were adjusted for age, sex, median income zip, history of aneurysm of carotid, iliac, and lower extremity artery, co-morbidities including diabetes, hypertension, smoking, obesity, chronic kidney disease, congestive heart failure, myocardial infarction, COPD, and atherosclerosis. Results: Our study included 132,775 and 36,010 weighted hospitalizations for endovascular and open AAA repair, respectively. The open AAA repair cohort were younger compared to those of endovascular AAA repair (mean age ± S.D: 65.0 ± 10.4 Vs.73.3 ± 9.0). A higher proportion of female underwent open AAA repair than endovascular AAA repair (33.5% vs. 20.9%). Across all racial/ethnic groups, endovascular repair for AAA was more common than open AAA repair among males, except for black males. A higher proportion of black males underwent open AAA repair than endovascular repair (5.7% vs. 3.9%). Patients who had open AAA repair had higher odds of death compared to those who had endovascular repair (Adjusted odds ratio [aOR], 5.99 [95% CI, 5.22-6.87]; p<.0001 ). Conversely, a higher odd of discharge to home/short term facility was noted among patients who had endovascular compared to open AAA repair (aOR, 5.83 [95% CI, 5.38 - 6.32]; p<.0001) . Conclusions: Disparities exist in the utilization of open versus endovascular AAA repair among hospitalized patients. Results could be used to support future research to examine factors driving these disparities.

Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association

Stent Graft-Induced Aortic Wall Injury—Anesthesia Pitfalls and Pearls for the Thoracic Endovascular Aortic Repair Procedure

Recently published long-term outcomes of the UK Endovascular Abdominal Aortic Aneurysm Repair (EVAR) trial investigators and the Dutch Randomized Endovascular Aneurysm Repair group have continued to demonstrate the superiority of EVAR in the perioperative period, but they have failed to establish long-term sustainable durability compared to open repair because of increased graft-related complications and reinterventions.1,2 In 2005, thoracic endovascular aneurysm repair (TEVAR) was approved in the United States for the treatment of descending thoracic aortic aneurysms (DTAAs). This approval, based on the results of a phase II trial3 evaluating the GORE TAG endovascular prosthesis (W.L. Gore and Associates, Newark, Delaware), led to a nationwide explosion in the use of thoracic endovascular techniques for managing DTAAs.4 Physicians had already been performing EVAR for more than a decade. Whereas EVAR was initially used to repair abdominal aneurysms with a favorable anatomy, its use later expanded to include complex cases involving a short aneurysmal neck, a tortuous aorta, and (more recently) aneurysmal rupture. Although TEVAR has only a brief history, a similar trend is obvious: This approach is being used with reasonable success to treat dissections and even ruptured aneurysms5; in addition, various new debranching techniques are allowing TEVAR to be applied to portions of the aorta previously deemed unapproachable. Article see p 2718 Najibi and colleagues6 reported the results of the first study to compare TEVAR with open aortic repair. Their series comprised 18 patients, and the control group included a historic cohort of patients who had undergone open aortic repair during the previous 3 years. Short-term follow-up data showed that the endovascular group had significantly shorter operative times, shorter hospital and intensive-care–unit stays, and less operative blood loss. Subsequently, Bavaria and associates7 reported the results of a phase II multicenter trial that assessed GORE …

Urgent endovascular repair for ruptured aortic aneurysm using computed tomography image fusion

Primary aortoenteric fistula following endovascular aortic repair due to type II endoleak

Volume-Outcome Relationships and Abdominal Aortic Aneurysm Repair

Comparison of Long-term Survival After Open vs Endovascular Repair of Intact Abdominal Aortic Aneurysm Among Medicare Beneficiaries

Endovascular aneurysm repair is associated with a significant reduction in perioperative mortality and morbidity compared with open aneurysm repair in the treatment of abdominal aortic aneurysm. However, this benefit decreases over time owing to increased reinterventions and late aneurysm rupture after endovascular repair. To compare long-term outcomes of endovascular vs open repair of abdominal aortic aneurysm. This multicenter retrospective cohort study used deidentified data with 6-year follow-up from the Medicare-matched Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database. Patients undergoing first-time elective endovascular or open abdominal aortic aneurysm repair from 2003 to 2018 were propensity score matched. Patients with ruptured abdominal aortic aneurysm, concomitant procedures, or prior history of abdominal aortic aneurysm repair, were excluded. Data were analyzed from January 1, 2003, to December 31, 2018. First-time elective endovascular or open repair for abdominal aortic aneurysm. The primary long-term outcome of interest was 6-year all-cause mortality, rupture, and reintervention. Secondary outcomes included 30-day mortality and perioperative complications. Among a total of 32 760 patients (median [IQR] age, 75 [70-80] years; 25 706 [78.5%] men) who underwent surgical abdominal aortic aneurysm repair, 28 281 patients underwent endovascular repair and 4479 patients underwent open repair. After propensity score matching, there were 2852 patients in each group. Open repair was associated with significantly lower 6-year mortality compared with endovascular repair (548 deaths [35.6%] vs 608 deaths [41.2%]; hazard ratio [HR], 0.83; 95% CI, 0.74-0.94; P = .002), with increases in mortality starting from 1 to 2 years (84 deaths [4.3%] vs 126 deaths [6.7%]; HR, 0.63; 95% CI, 0.48-0.83; P = .001) and 2 to 6 years (211 deaths [25.8%] vs 241 deaths [30.6%]; HR, 0.73; 95% CI, 0.61-0.88; P = .001). Open repair, compared with endovascular repair, also was associated with significantly lower rates of 6-year rupture (117 participants [5.8%] vs 149 participants [8.3%]; HR, 0.76; 95% CI, 0.60-0.97; P < .001) and reintervention (190 participants [11.6%] vs 267 participants [16.0%]; HR, 0.67; 95% CI, 0.55-0.80; P < .001). Open repair was associated with significantly higher odds of 30-day mortality (OR, 3.56; 95% CI, 2.41-5.26; P < .001) and complications. These findings suggest that overall mortality after elective abdominal aortic aneurysm repair was higher with endovascular repair than open repair despite reduced 30-day mortality and perioperative morbidity after endovascular repair. Endovascular repair additionally was associated with significantly higher rates of long-term rupture and reintervention. These findings emphasize the importance of careful patient selection and long-term follow-up surveillance for patients who undergo endovascular repair.

Quality of life before and after endovascular and retroperitoneal abdominal aortic aneurysm repair

Thoracic endovascular aortic repair of aortobronchial fistulas

Editors' commentary

Diagnosis of Type III Endoleak and Endovascular Treatment with Aortouniiliac Stent-Graft

Editors' commentary