Elective repair of intact abdominal aortic aneurysms in a new center

BACKGROUND: Centralization of abdominal aortic aneurysm (AAA) care is widely promoted by societal guidelines and patient-safety organizations due to the well-established inverse relationship between procedural volume and outcomes. However, consistent regionalization remains difficult to achieve globally, as patient- and provider-level factors, economic considerations, and geographic barriers vary widely across different countries and care delivery models. As new aortic programs emerge, it remains unclear whether newly founded centers - particularly those staffed by experienced surgeons - can achieve outcomes comparable to high-volume institutions, and whether these centers should be excluded from providing AAA care. This study evaluates short- and mid-term outcomes of elective AAA repair at a newly established vascular surgery center. METHODS: We conducted a retrospective analysis of prospectively collected data from consecutive patients who underwent elective infrarenal intact AAA repair between 2020-2024. Primary outcomes included in-hospital and late mortality, as well as major adverse cardiovascular events (MACE). RESULTS: A total of 129 patients underwent elective AAA repair: 110 received endovascular aneurysm repair (EVAR) and 19 underwent open surgical repair (OSR). Experienced surgeons (defined as >7-years of independent practice and >150 prior AAA repairs) performed 75% of cases. EVAR was associated with significantly shorter operative time (110 vs. 180 minutes, P<0.001), less blood loss, and reduced hospital stay (4 vs. 9 days, P<0.001). The overall 30-day mortality was 1.5%, with no significant difference between EVAR and OSR groups. The 30-day MACE rates were significantly different between groups (0.9% in EVAR vs. 10.5% in OSR group, P=0.01). Acute kidney injury (AKI) occurred in 8.2% of EVAR patients and in 21% of OSR patients (P=0.19), with no progression to end-stage kidney disease. EVAR was associated with a non-significant trend towards lower 30-day MACE (OR 0.10, 95% CI: 0.004-2.29, P=0.15). Multivariable analysis demonstrated that EVAR was associated with significantly lower likelihood of AKI (OR 0.11, 95% CI: 0.02-0.52, P=0.005) while age ≥80 was associated with increased AKI risk (OR 3.78, 95% CI: 0.98-14.58, P=0.05). Mid-term outcomes showed no significant differences in AAA-related mortality or reintervention rates between groups. CONCLUSIONS: Elective AAA repair at a newly established vascular center staffed by experienced surgeons is safe and effective, demonstrating low rates of MACE and mortality. These findings suggest that AAA care can be successfully provided outside traditional high-volume centers, supporting a more flexible approach to hospital and surgeon accreditation that also considers provider experience rather than volume thresholds alone.