The importance of and current trends in the endovascular program – A single center experience

Abstract

IntroductionOpen vascular surgery and endovascular (EV) interventions are continually developing and their application differs depending on the arterial regions treated. We aim to demonstrate that current EV procedures do not mean a restriction, but on the contrary, an increase in the number of patients who can be successfully treated. MethodsWe have retrospectively followed all open surgery procedures and endovascular interventions done for carotid artery stenosis and subrenal abdominal aortic aneurysms (AAA) from 1990/1993 to 2014 in the Vascular Surgery Department at Na Homolce Hospital. ResultsFrom 1990 to 2014, 1659 open AAA surgery procedures were done in our department. Since 1996, 1023 endovascular abdominal aortic aneurysm repairs (EVAR) have been performed and since the implementation of robotics, 64 aneurysm replacements were robot-assisted. Mortality rates in the OS, EVAR and robotic groups are 1.7%, 1.5% and 0.4%, respectively. The percentage of EVAR stabilized during the last 5 years at about 32% of the total number of treated patients. From 1993 to 2014 there were 5363 open carotid surgery procedures done in our department, 2856 for symptomatic and 2507 for asymptomatic stenosis. The total cohort combined stroke/death rate was 1.6%. Symptomatic, asymptomatic and urgently operated patients had a combined 30-day stroke/death rate of 1.0%, 1.7% and 4.4%, respectively. During the same period 274 carotid bifurcation and 55 common carotid artery percutaneous transluminal angioplasty (PTA) were done. The technical success of endovascular interventions was better than 95%. ConclusionIn the AAA group, the percentage of EVAR stabilized during the last 5 years at about 32% of the total number of treated patients. Given the excellent results of open carotid surgery and the unconvincing results of stenting trials, we consider open carotid surgery to be better than carotid artery primary stenting.