September 5, 2023European Journal of Radiology OpenOpen Access

Exploiting endovascular aortic repair as a minimally invasive method – Nine years of experience in a non-university hospital

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Why the study?

The authors sought to assess whether a non-university hospital could over time adopt EVAR as a minimally invasive method in elective and emergency settings, while monitoring complications, secondary interventions, and mortality.

What are the long-term outcomes, complications, and survival rates of EVAR performed in a non-university hospital setting?

Structured PICO

What are the long-term outcomes, complications, and survival rates of EVAR performed in a non-university hospital setting?

Population

207 patients treated with endovascular aortic repair (EVAR), including 6 with rupture, at a non-university hospital between November 2013 and March 2022

Intervention

Endovascular aortic repair (EVAR)

Outcome

Treatment quality in terms of complications, secondary interventions, and mortalityhard clinical

EVAR can be safely and effectively performed in a low-volume non-university hospital, achieving complication and survival rates comparable to larger vascular centers.

Implication

Supports EVAR in non-university settings with these rates; leaves open generalizability and volume-outcome effects.

Abstract

Background: At the introduction of endovascular aortic repair (EVAR) in 2013 in our non-university hospital, we established a quality registry to monitor our EVAR activity. Purpose: To observe if we over time were able to exploit EVAR as a minimally invasive method in an elective as well as emergency setting, and to monitor our treatment quality in terms of complications, secondary interventions and mortality. Material and methods: From November 2013 to March 2022, we treated 207 patients with EVAR, including six patients with rupture. Follow-up regimen was partly based on contrast-enhanced computer tomography, and partly on contrast-enhanced ultrasound in combination with plain radiography. Results: During the observation period, the method of anesthesia changed from general, via spinal, to local anesthesia. The groin access changed from surgical cut down to percutaneous and the median length of postoperative stay decreased from 3 days to 1 day. EVAR on ruptured aneurysm was done for the first time in 2019. Endoleak was detected in 85 patients (42%) and 37 patients (18%) had one or more secondary interventions, of which 85% were endovascular. Estimated five-year survival was 72% in patients below 80 years of age and 45% in patients 80 years or older. Conclusion: Nine years of experience enabled us to exploit EVAR's advantages as a minimally invasive method in an elective as well as emergency setting. Complications, secondary interventions and survival rates in our low volume non-university hospital matches results from larger vascular centers.