Clinical Outcomes of Open and Endovascular Abdominal Aortic ...

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Open Repair from a Single Institution ... with open repair (OR) or endovascular repair using fenes- ... California Los Angeles School of Medicine, Los Angeles,.
JOURNAL OF VASCULAR SURGERY Volume 63, Number 6S

Conclusions: Use of Ovation stent graft in the absence of a suitable neck length of 7 mm was not associated with poor outcomes in the midterm period. These data show that the use of Ovation system for the treatment of infrarenal abdominal aortic aneurysm is not restricted by the conventional measurement of aortic neck length, as confirmed by the recent FDA-approved changes to the indication statement. Author Disclosures: L. Bresadola: Nothing to disclose; P. Castelli: Nothing to disclose; R. Chiesa: Nothing to disclose; G. de Donato: Nothing to disclose; N. Mangialardi: Nothing to disclose; G. Nano: Nothing to disclose; C. Setacci: Nothing to disclose; F. Setacci: Nothing to disclose. PC028. PC028 Management of Complex Abdominal Aortic Aneurysms: Results of Endovascular and Open Repair from a Single Institution Jesse M. Manunga, MD, Timothy Sullivan, MD, Jessica Titus, MD, Jason Alexander, MD, Peter Alden, MD, Elliot Stephenson, MD, Nedaa Skeik, MD, Andrew Cragg, MD. Abbott Northwestern Hospital, Minneapolis, Minn Objectives: This study evaluated outcomes of patients with complex abdominal aortic aneurysms (cAAA) treated with open repair (OR) or endovascular repair using fenestrated stent graft (F-EVAR). Methods: A retrospective review of consecutive patients with cAAA treated electively by OR or F-EVAR between 2010 and 2015 at Abbott Northwestern Hospital was conducted. Patient demographics, cardiovascular risk factors, procedure time, complications, estimated blood loss (EBL), ICU and hospital length of stay (HLOS) were recorded. End points included 30-day mortality, endoleaks, target vessel loss/patency, and conversion to OR. Results: During this period, 103 patients (OR, 56; FEVAR: 47) underwent repair of cAAA. Majority were males (OR, 49; F-EVAR: 37) with a mean age of 75.7 years (F-EVAR) and 72 years (OR). There were more patients with CAD (95.7% vs 46.4%; P < .001) and COPD (65.9% vs 28.5%; P < .001) in the F-EVAR group than in the OR group. The mean SVS/AAVS comorbidity severity score was 16 in the F-EVAR group and 7 in the OR group (P < .001). In the F-EVAR group, 132 vessels were targeted (renal: 84, SMA: 39, celiac: 4, and iliac: 5) with 100% technical success rate. One type I endoleak resolved on follow-up CT scan. Two renal arteries were lost in the F-EVAR and 1 in the OR group. Procedure length, EBL, ICU and HLOS were higher (312 minutes, 1800 mL, 3 days, and 8 days vs 190 minutes, 200 mL, 1.06 days, and 2 days; P < .001) in OR compared to FEVAR group. Transfusion requirements were higher in the OR group (100% vs 2.13%; P < .001). EBL was higher in patients whose clamp site was suprarenal compared to infrarenal (2700 mL vs 1100 mL; P < .003). Thirty-day mortality was 2.13% in the F-EVAR group and 3.57% in the OR group. More patients were discharged to home after F-EVAR than after OR (97.9% vs 62.5%; P < .001). With a mean follow-up of 12.9 months (F-EVAR) and 40.2 months (OR), the rate of secondary intervention was 6.38% and 5.36% (P ¼ NS), respectively.

Abstracts 161S

Conclusions: F-EVAR was as effective as OR at treating patients with cAAA. Furthermore, outcomes in high surgical risk patients undergoing F-EVAR is comparable to low surgical risk patients treated with OR. F-EVAR offers less operative time, less transfusion requirements, decreased ICU, and HLOS and faster convalescence. As durability is demonstrated and the technology is disseminated, F-EVAR has the potential of overtaking OR as the standard of care for patients with cAAA. Author Disclosures: P. Alden: Nothing to disclose; J. Alexander: Nothing to disclose; A. Cragg: Nothing to disclose; J. M. Manunga: Cook Medical: consulting fees (eg, advisory boards); N. Skeik: Nothing to disclose; E. Stephenson: Nothing to disclose; T. Sullivan: Nothing to disclose; J. Titus: Nothing to disclose. PC030 PC030. Clinical Outcomes of Open and Endovascular Abdominal Aortic Aneurysm Repair Over a 15-Year Period in the Veteran Population Sinan Jabori, BS1, Gloria Y. Kim, MD, MPH2, Elizabeth Lancaster, MD2, Christian de Virgilio, MD3, Jessica O’Connell, MD2, David Rigberg, MD2, Hugh Gelabert, MD2. 1University of California Los Angeles School of Medicine, Encino, Calif; 2University of California Los Angeles School of Medicine, Los Angeles, Calif; 3Harbor-UCLA Medical Center, Torrance, Calif Objectives: 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. Methods: 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. Results: 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. Conclusions: Our study is consistent with the national trend toward EVAR as the preferred approach

JOURNAL OF VASCULAR SURGERY June Supplement 2016

162S Abstracts

PC032 PC032. Preliminary Results of a Prospective Trial of Endovascular Aortic Aneurysm Repair as Day Surgery Stephen C. Hanley, MD, PhD1, Oren K. Steinmetz, MD, FRCSC1, Eva S. Mathieu, PhD, CCRP2, Daniel I. Obrand, MD3, Kent S. MacKenzie, MD1, Marc-Michel Corriveau, MD1, Cherrie Z. Abraham, MD, FRCSC4, Heather L. Gill, MD, MPH1. 1McGill University Health Centre, Montreal, PQ, Canada; 2Research Institute of the McGill University Health Centre, Montreal, PQ, Canada; 3 Jewish General Hospital, Montreal, PQ, Canada; 4 Oregon Health & Science University, Portland, Ore

Fig. Open AAA repair and EVAR survival over 15 years.

Table. Open repair and endovascular aneurysm repair (EVAR) in 212 patients

Perioperative complications (30-day mortality) Creatinine elevation Dialysis Creatine kinase elevation Surgical site infection Graft infection Pneumonia Late morbidity (>30 days) Claudication Incisional hernia Graft infection Erectile dysfunction AAA enlargement Migration Rupture Mortality 30 days 6 months 1 year 2 years 5 years 10 years Endoleak (>30 days) Type I Type II

Open repair

EVAR

n ¼ 91 (42.9%), No. (%)

n ¼ 121 (57%), No. (%)

P value

6 2 3 6 1 10

(6.6) (2.2) (3.2) (6.6) (1.1) (10.9)

0 1 0 2 1 0

(0.0) (0.8) (0.0) (1.6) (0.8) (0.0)

.003 .38 .39 .036 .812 .001

4 5 0 4 2 0 0

(4.4) (5.4) (0.0) (4.4) (2.1) (0.0) (0.0)

10 1 0 5 20 1 0

(8.3) (8.2) (0.0) (4.1) (16.5) (0.8) (0.0)

.305 .016

2 5 8 11 24 38

(2.2) (5.4) (8.7) (12.1) (26.1) (41.8)

0 (0.0) 2 (16.5) 4 (3.3) 6 (4.9) 17 (14.0) 19 (15.8) 27 (22.73) 7 24

.807 .002 .008 .099 .116 .081 .030 .013