PC030. Clinical Outcomes of Open and Endovascular Abdominal Aortic Aneurysm Repair Over a 15-Year Period in the Veteran Population

Abstract

Disease acuity and perioperative morbidity amongst Veterans is considered to be greater than in the general U.S. population. The reduced morbidity and mortality associated with endovascular aneurysm repair (EVAR) hold promise of improving safety of management of abdominal aortic aneurysms (AAA) in this population. We examine the outcomes of open repair and EVAR, over a 15-year period, in a Veteran population at our regional VA Medical Center. With IRB approval, a retrospective review was conducted of all patients who underwent open infrarenal open AAA repair and EVAR at a single VA hospital between 2000 and 2015. Emergency AAA repairs were excluded. Open and EVAR groups were compared. Variables reviewed include demographics, medical history, surgical details, complications (perioperative and late), and mortality. The primary end points were 30-day, 6-month, 1-year, and 2-year mortality. Survival was estimated using actuarial life-table method. During the 15-year study period, 212 patients (mean age, 71.44 years) underwent 91 open (70.37 years) and 121 endovascular (72.56 years) AAA repairs (Table). Perioperative (30-day) complications, including pneumonia, creatinine elevation, and surgical site infection, were significantly increased in the open group. Need for dialysis, graft infection, pulmonary embolism, cardiac enzyme elevation were not different between groups. Mortality was greater in the open group (3) than the EVAR group (0), but this was not statistically significant. Late morbidity was not significantly different between groups ,with exception of endoleaks and aortic enlargement after EVAR. The EVAR group had 27 (22.73%) endoleaks (7 type I and 24 type II), 20 (18.2%), and 15 (12.3%) required interventions. Our study is consistent with the national trend toward EVAR as the preferred approach for AAA repair. Overall perioperative mortality for AAA repairs (0% EVAR, 2% open) was below the national average. Mortality at 2 years was similar for the open and EVAR groups. Our study supports EVAR as a safe elective operation with low mortality and few complications in a group of patients who are characterized by greater disease acuity and elevated complication rates. With lower perioperative mortality and shorter recovery time, EVAR has become the preferred method of AAA management in the Veteran population.TableOpen repair and endovascular aneurysm repair (EVAR) in 212 patientsPerioperative complications (30-day mortality)Open repairEVARP valuen = 91 (42.9%), No. (%)n = 121 (57%), No. (%)Creatinine elevation6 (6.6)0 (0.0).003Dialysis2 (2.2)1 (0.8).38Creatine kinase elevation3 (3.2)0 (0.0).39Surgical site infection6 (6.6)2 (1.6).036Graft infection1 (1.1)1 (0.8).812Pneumonia10 (10.9)0 (0.0).001Late morbidity (>30 days) Claudication4 (4.4)10 (8.3).305 Incisional hernia5 (5.4)1 (8.2).016 Graft infection0 (0.0)0 (0.0) Erectile dysfunction4 (4.4)5 (4.1).807 AAA enlargement2 (2.1)20 (16.5).002 Migration0 (0.0)1 (0.8).008 Rupture0 (0.0)0 (0.0)Mortality 30 days2 (2.2)0 (0.0).099 6 months5 (5.4)2 (16.5).116 1 year8 (8.7)4 (3.3).081 2 years11 (12.1)6 (4.9).030 5 years24 (26.1)17 (14.0).013 10 years38 (41.8)19 (15.8)<.001Endoleak (>30 days)27 (22.73) Type I7 Type II24AAA, Abdominal aortic aneurysm. Open table in a new tab