Three decades of experience of a national reference aortic center in the treatment of aortic diseases

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Aortic diseases (aneurysmal and occlusive pathologies of the abdominal, thoracic, and thoracoabdominal aorta). Intervention: Open surgical, endovascular (EVAR, TEVAR, BEVAR, CERAB), and hybrid aortic repair procedures. Primary outcome: Procedural volume and longitudinal clinical practice trends.

Q: What does this research mean for the field?

Centralization and technological evolution in a national reference aortic center over three decades are accompanied by substantial increases in procedural volume and complexity for open and endovascular aortic surgeries. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Igor B. KONCAR; Nikola Ilić; Vladimir Cvetić; Milos M. SLADOJEVIC; Ivan Tomić; Perica Mutavdžić; Borivoje Lukić; Ksenija Jovanović; Lazar B Davidovic; Marko Dragaš

doi:10.5937/siks2601018k

January 1, 2026Srce i krvni sudoviOpen Access

Three decades of experience of a national reference aortic center in the treatment of aortic diseases

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Key result

Aortic procedure volumes increase over three decades, led by ~10,600 open and endovascular AAA repairs.

Why the study?

Aortic diseases, including aneurysmal and occlusive pathologies, are among the most complex cardiovascular conditions, prompting an evaluation of three decades of experience in procedural volume, technological innovation, and treatment outcomes at a national reference aortic center.

Key Points

To review three decades of clinical practice, procedural trends, and therapeutic evolution in treating complex aortic diseases at a national reference center.
Retrospective analysis of aortic procedures performed at a national reference center between 1991 and 2026.
Analyzed records of 14,699 patients treated for abdominal aortic disease from 1994 to 2026, including 11,929 abdominal aortic aneurysm (AAA) and 2,770 aortoiliac occlusive disease cases.
Evaluated procedural types and approaches among 10,558 surgical patients treated between 1991 and 2026, comparing open surgery and endovascular aneurysm repair (EVAR).
Among 10,558 surgical AAA patients from 1991 to 2026, 9,609 underwent open surgical repair and 949 underwent EVAR, encompassing 7,749 elective and 1,860 ruptured aneurysm procedures alongside more than 400 open thoracoabdominal repairs.
Elective open surgical repair achieved an institutional mortality rate of approximately 1%, while mortality for ruptured aneurysms decreased from nearly 50% to slightly above 30% over two decades.
The introduction of EVAR in 2007 and hybrid operative suites expanded intervention options for older individuals with major cardiorespiratory comorbidities.

Study Design

Type

Observational

Multicenter

No

Structured PICO

P

Population

Patients with abdominal, thoracic, and thoracoabdominal aortic diseases (including 14,699 with abdominal aortic disease from 1994-2026) treated with open, endovascular, or hybrid procedures at a single Serbian reference center between 1991 and 2026.

E

Exposure

Open surgical, endovascular, and hybrid aortic procedures performed over three decades, including open surgical repair (OSR) of AAA (n=9,609) and thoracoabdominal aortic aneurysms (n=444), endovascular aneurysm repair (EVAR, n=949), thoracic endovascular aortic repair (TEVAR), branched endovascular aortic repair (BEVAR, n=7), hybrid thoracic procedures (n=244, including carotid-subclavian bypass, carotid-carotid-subclavian bypass, total debranching, visceral debranching, physician-modified stent grafts, and chimney stents), and aortoiliac revascularization (aortobifemoral bypass, percutaneous balloon angioplasty, stenting, drug-eluting balloons, atherectomy, lithotripsy, and covered endovascular reconstruction of the aortic bifurcation [CERAB]).

O

Outcome

Procedural volume, relative frequency of different types of operations, technological evolution, and longitudinal trends in clinical practice from 1991 to 2026 (treatment outcomes over the entire study period could not be consistently presented due to data limitations).

Limitations

Retrospective investigation design
Inability to present treatment outcomes consistently over the entire three-decade study period due to data limitations
Study periods were not identical across different disease entities or procedures, as techniques were introduced at different times
Single-center experience
Retrospective investigation
Impossible to present treatment outcomes consistently over the entire study period due to data limitations
The study period is not identical for different disease entities or procedures, as not all procedures were performed during the same time intervals

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Implication

This three-decade retrospective review of a high-volume Serbian national reference aortic center highlights a substantial expansion in procedural volume and complexity, demonstrating a steady transition toward endovascular and hybrid techniques alongside open surgical repair.

Abstract

Background: Aortic diseases, including aneurysmal and occlusive pathologies, represent some of the most complex conditions in cardiovascular medicine. This study aims to present three decades of clinical experience from a national reference aortic center, highlighting changes in procedural volume, technological innovation, and treatment outcomes. Methods: We conducted a retrospective analysis of all aortic procedures performed at the National Reference Aortic Center from 1991 to 2026. Data were collected from annual clinical reports and included open and endovascular interventions for abdominal aortic aneurysm (AAA), ruptured AAA (RAAA), thoracic and thoracoabdominal aortic disease, and aortoiliac occlusive disease. Descriptive statistics were used to summarize patient characteristics, procedural trends, and longitudinal changes in clinical practice. Results: Over the study period, both the number and complexity of aortic procedures increased significantly. Abdominal aortic aneurysm treatment accounted for the majority of cases, with substantial growth in elective and emergency interventions. The team has developed in open thoracoabdiminal surgery performing more that 400 procedures so far. The implementation of endovascular aneurysm repair broadened therapeutic options, particularly for high-risk patients unsuitable for open surgery. The center also adopted hybrid operating room technology, enhancing the safety and efficacy of complex procedures. Multidisciplinary care involving surgeons, interventional radiologists, anesthesiologists, and specialists in thrombosis and hemostasis facilitated individualized treatment planning. Conclusion: The increasing prevalence of aortic pathology underscores the importance of prevention, screening, and centralized care. Continued expansion of endovascular programs and access to advanced technologies is essential to further improve clinical outcomes.

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Cite This Study

KONCAR et al. (2026) conducted an observational in Aortic diseases (aneurysmal and occlusive pathologies of the abdominal, thoracic, and thoracoabdominal aorta). Open surgical, endovascular (EVAR, TEVAR, BEVAR, CERAB), and hybrid aortic repair procedures was evaluated on Procedural volume and longitudinal clinical practice trends. Open and endovascular aortic procedures increased over three decades, including 10,558 AAA surgeries (9,609 open, 949 EVAR), 444 open thoracoabdominal repairs, and 244 thoracic hybrid procedures.

synapsesocial.com/papers/6af3463ebdf2424ebd04f804 https://doi.org/10.5937/siks2601018k

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Three decades of experience of a national reference aortic center in the treatment of aortic diseases

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Three decades of experience of a national reference aortic center in the treatment of aortic diseases

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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