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Year 2021, , 167 - 176, 01.07.2021

Ferit Kasımzade , Levent Yazıcıoğlu

https://doi.org/10.7197/cmj.912685

Abstract

References

  • 1. Rutherford RB, Cronenwett JL, Gloviczki P, Johnston KW, Kempczinski RF, Krupski WC, editors. Vascularsurgery. 5th ed. Philadelphia: W. B. SaundersCompany; 2000. p. 1246-8.
  • 2. Jaunoo S. Endovascular aneurysm repair (EVAR). Int J Surg 2008;6:266-269.
  • 3. Wyatt M.G (1999) Aneurysmal disease. In: Davies A.H, editor. VascularSurgeryHighlights 1998-1999. Oxford: HealthPress. p. 41-8.
  • 4. Garcia-Madric C, Josa M, Riambau V, Mestres C.A,Muntana J, Mulet J. Endovascularversusopensurgical repair of abdominal aorticaneurysm: a comparisonofearlyandintermediate results in patients suitable for both techniques. Eur J VascEndovasc Surg. 2004;28:365-72.
  • 5. Melton L, Bickerstaff L, Hollier, Van Peenen HJ, Lie JT, Pairolero PC, L et al. Changingincidence of abdominal aorticaneurysms: A population-basedstudy. Am J Epidemiol. 1984;120:379-86.
  • 6. Reilly J.M, Tilson M.D (1989) Incidence and etiology of abdominal aortic aneurysms.Surg Clin North Am. 69:705-711.
  • 7. Parodi JC. Endovascularrepair of abdominalaorticaneurysmsandother arterial lesions. SurgTechnolInt 1994;3:431-6.
  • 8. Ricotta JJ II, Malgor RD, Oderich GS. Endovascular abdominal aorticaneurysm repair: part I. AnnVascSurg 2009;23(6):799-812.
  • 9. Köksal C, Özcan V, Sarıkaya S, Meydan B, Zengin M, Numan F. Supplemental vascularprocedurefor endovascular aneurysm repair. TurkGogus Kalp Dama 2004;12:254-8.
  • 10. Duarte MP, Maldjian CT, Laskowski I. Comparison of endovascular versus open repair of abdominal aortic aneurysms: a review. CardiolRev 2009;17:112-4.
  • 11. Karabay Ö. Abdominal aorta patolojilerinde endovasküler tedavi. Türkiye Klinikleri J CardiovascSurg-Special Topics; 2009;2;46-54.
  • 12. Tanquilut EM, Ouriel K. Current outcomes in endovascular repair of abdominal aortic aneurysms. J CardiovascSurg2003;44:503-9.
  • 13. Upchurch GR Jr, Eliason JL, Rectenwald JE, Escobar G, Kabbani L, Criado E. Endovascular abdominal aortic aneurysm repair versusopenrepair: whyandwhy not? PerspectVascSurgEndovasc Ther 2009;21:48-53.
  • 14. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trialparticipants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operativemortalityresults: randomisedcontrolledtrial. Lancet 2004;364:843-8.
  • 15. Buth J, vanMarrewijk CJ, Harris PL, Hop WC, Riambau V, Laheij RJ, et al. Outcome of endovascular abdominal aortic aneurysm repair in patients withconditionsconsideredunfitfor an open procedure: a report on the EUROSTAR experience. J Vasc Surg 2002;35:211-21.
  • 16. Malina M, Nilsson M, Brunkwall J, Ivancev K, Resch T, Lindblad B. Quality of life before and after endovascular and open repair of asymptomatic AAAs: a prospective study. J Endovasc Ther 2000;7:372-9.
  • 17. Raval MV, Eskandari MK. Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair. Surgery 2012;151:245-60.
  • 18. Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in theMedicarepopulation. N Engl J Med 2008;358:464-74.
  • 19. Jordan WD, Alcocer F, Wirthlin DJ, Westfall AO, Whitley D. Abdominal aortic aneurysms in “high-risk” surgical patients: comparison of open and endovascular repair. AnnSurg 2003;237:623-9.
  • 20. Becquemin JP, Pillet JC, Lescalie F, Sapoval M, Goueffic Y, Lermusiaux P, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- tomoderate-risk patients. J VascSurg 2011;53:1167-73.
  • 21. Maher MM, McNamara AM, MacEneaney PM, Sheehan SJ, Malone DE. Abdominal aortic aneurysms: elective endovascular repair versus conventionalsurgery-evaluationwithevidence-basedmedicinetechniques. Radiology 2003;228:647-58.
  • 22. Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg 2006;44:16-21.
  • 23. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009;302:1535-42.
  • 24. May J, White GH, Yu W, Ly CN, Waugh R, Stephen MS, et al. Concurrentcomparison of endoluminal versus open repair in the treatment of abdominal aortic aneurysms: analysis of 303 patients by life table method. J Vasc Surg 1998;27:213-20.
  • 25. Brewster DC, Geller SC, Kaufman JA, Cambria RP, Gertler JP, LaMuraglia GM, et al. Initialexperiencewithendovascular aneurysm repair: comparison of earlyresultswithoutcome of conventional open repair. J Vasc Surg 1998;27:992-1003.
  • 26. Zarins CK, Wolf YG, Lee WA, Hill BB, Olcott C IV, Harris EJ, et al. Will endovascular repair replace open surgery for abdominal aortic aneurysm repair? Ann Surg 2000;232:501-7.
  • 27. Beebe HG, Cronenwett JL, Katzen BT, Brewster DC, Green RM; VanguardEndograft Trial Investigators. Results of an aorticendografttrial: impact of devicefailurebeyond 12 months. J VascSurg 2001;33:55-63.

Comparison of early-late results and cost effectivity of open surgical treatment and endovascular interventions in abdominal aortic aneurysms

Year 2021, , 167 - 176, 01.07.2021

Ferit Kasımzade , Levent Yazıcıoğlu

https://doi.org/10.7197/cmj.912685

Abstract

Objective: In this study, we aimed to compare early and late outcomes of patients with abdominal aortic aneurysm (AAA) treated using an endovascular approach and open aneurysm repair technique.
Method: A total of 171 patients who were undergoing EVAR and open surgical therapy were retrospectively analyzed under elective conditions due to abdominal aortic aneurysm via Hospital Info Management System and archive files within May 2006 and June 2014, in the Ankara University Cardiovascular Department. 126 of the patients (73,7%) were treated by endovascular (group 1) and 45 of them (26,3%) were treated with open surgery (group 2) technique. Patients with 5,5 cm or large asymptomatic aneurysms and symptomatic patients with diameter smaller than 5,5 cm are classified by aneurysm morphology evaluating preoperative CT angiography images and risk scores were made and considering the other comorbidities early and late morbidity mortality, reintervention rates, transfusion needs, hospital stay and cost effectiveness of EVAR were compared.
Results: The mortality rate for patients undergoing EVAR was 2,4%, while in patients undergoing open surgical repair was found 8,9% (p <0.05). The mean length of ICU, and hospital stay were significantly lower in the patients undergoing EVAR, in comparison with open surgery. The amount of blood transfusion in patients undergoing EVAR was significantly lower than in patients treated with open surgery. It can be observed an increase in early endoleak (leakage) rates constituting 9,5% in EVAR patients, which was dropped to 3,2% in sixthmonth control. According to the consequences of cost effectiveness, it was obtained that endovascular group is considerably expensive treatment than open surgery. It should be pointed out that the post implantation syndrome rates were 14,2% and there was not noted any change on mortality outcomes.
Conclusions: EVAR is a safe in early and long term follow-up that reduces mortality range in all age groups, especially over 70 years old, and in patients with comobrid factors. Therefore, EVAR treatment should be considered as a priority in anatomically suitable patients despite its high cost effectiveness.

Keywords

abdominal aortic aneurysms open surgical treatment endovascular intervention EVAR cost effectivity

References

  • 1. Rutherford RB, Cronenwett JL, Gloviczki P, Johnston KW, Kempczinski RF, Krupski WC, editors. Vascularsurgery. 5th ed. Philadelphia: W. B. SaundersCompany; 2000. p. 1246-8.
  • 2. Jaunoo S. Endovascular aneurysm repair (EVAR). Int J Surg 2008;6:266-269.
  • 3. Wyatt M.G (1999) Aneurysmal disease. In: Davies A.H, editor. VascularSurgeryHighlights 1998-1999. Oxford: HealthPress. p. 41-8.
  • 4. Garcia-Madric C, Josa M, Riambau V, Mestres C.A,Muntana J, Mulet J. Endovascularversusopensurgical repair of abdominal aorticaneurysm: a comparisonofearlyandintermediate results in patients suitable for both techniques. Eur J VascEndovasc Surg. 2004;28:365-72.
  • 5. Melton L, Bickerstaff L, Hollier, Van Peenen HJ, Lie JT, Pairolero PC, L et al. Changingincidence of abdominal aorticaneurysms: A population-basedstudy. Am J Epidemiol. 1984;120:379-86.
  • 6. Reilly J.M, Tilson M.D (1989) Incidence and etiology of abdominal aortic aneurysms.Surg Clin North Am. 69:705-711.
  • 7. Parodi JC. Endovascularrepair of abdominalaorticaneurysmsandother arterial lesions. SurgTechnolInt 1994;3:431-6.
  • 8. Ricotta JJ II, Malgor RD, Oderich GS. Endovascular abdominal aorticaneurysm repair: part I. AnnVascSurg 2009;23(6):799-812.
  • 9. Köksal C, Özcan V, Sarıkaya S, Meydan B, Zengin M, Numan F. Supplemental vascularprocedurefor endovascular aneurysm repair. TurkGogus Kalp Dama 2004;12:254-8.
  • 10. Duarte MP, Maldjian CT, Laskowski I. Comparison of endovascular versus open repair of abdominal aortic aneurysms: a review. CardiolRev 2009;17:112-4.
  • 11. Karabay Ö. Abdominal aorta patolojilerinde endovasküler tedavi. Türkiye Klinikleri J CardiovascSurg-Special Topics; 2009;2;46-54.
  • 12. Tanquilut EM, Ouriel K. Current outcomes in endovascular repair of abdominal aortic aneurysms. J CardiovascSurg2003;44:503-9.
  • 13. Upchurch GR Jr, Eliason JL, Rectenwald JE, Escobar G, Kabbani L, Criado E. Endovascular abdominal aortic aneurysm repair versusopenrepair: whyandwhy not? PerspectVascSurgEndovasc Ther 2009;21:48-53.
  • 14. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trialparticipants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operativemortalityresults: randomisedcontrolledtrial. Lancet 2004;364:843-8.
  • 15. Buth J, vanMarrewijk CJ, Harris PL, Hop WC, Riambau V, Laheij RJ, et al. Outcome of endovascular abdominal aortic aneurysm repair in patients withconditionsconsideredunfitfor an open procedure: a report on the EUROSTAR experience. J Vasc Surg 2002;35:211-21.
  • 16. Malina M, Nilsson M, Brunkwall J, Ivancev K, Resch T, Lindblad B. Quality of life before and after endovascular and open repair of asymptomatic AAAs: a prospective study. J Endovasc Ther 2000;7:372-9.
  • 17. Raval MV, Eskandari MK. Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair. Surgery 2012;151:245-60.
  • 18. Schermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE. Endovascular vs. open repair of abdominal aortic aneurysms in theMedicarepopulation. N Engl J Med 2008;358:464-74.
  • 19. Jordan WD, Alcocer F, Wirthlin DJ, Westfall AO, Whitley D. Abdominal aortic aneurysms in “high-risk” surgical patients: comparison of open and endovascular repair. AnnSurg 2003;237:623-9.
  • 20. Becquemin JP, Pillet JC, Lescalie F, Sapoval M, Goueffic Y, Lermusiaux P, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- tomoderate-risk patients. J VascSurg 2011;53:1167-73.
  • 21. Maher MM, McNamara AM, MacEneaney PM, Sheehan SJ, Malone DE. Abdominal aortic aneurysms: elective endovascular repair versus conventionalsurgery-evaluationwithevidence-basedmedicinetechniques. Radiology 2003;228:647-58.
  • 22. Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data. J Vasc Surg 2006;44:16-21.
  • 23. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009;302:1535-42.
  • 24. May J, White GH, Yu W, Ly CN, Waugh R, Stephen MS, et al. Concurrentcomparison of endoluminal versus open repair in the treatment of abdominal aortic aneurysms: analysis of 303 patients by life table method. J Vasc Surg 1998;27:213-20.
  • 25. Brewster DC, Geller SC, Kaufman JA, Cambria RP, Gertler JP, LaMuraglia GM, et al. Initialexperiencewithendovascular aneurysm repair: comparison of earlyresultswithoutcome of conventional open repair. J Vasc Surg 1998;27:992-1003.
  • 26. Zarins CK, Wolf YG, Lee WA, Hill BB, Olcott C IV, Harris EJ, et al. Will endovascular repair replace open surgery for abdominal aortic aneurysm repair? Ann Surg 2000;232:501-7.
  • 27. Beebe HG, Cronenwett JL, Katzen BT, Brewster DC, Green RM; VanguardEndograft Trial Investigators. Results of an aorticendografttrial: impact of devicefailurebeyond 12 months. J VascSurg 2001;33:55-63.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Medical Science Research Articles
Authors

Ferit Kasımzade 0000-0003-3646-3181

Levent Yazıcıoğlu 0000-0002-7499-2706

Publication Date July 1, 2021
Acceptance Date June 7, 2021
Published in Issue Year 2021

Cite

AMA Kasımzade F, Yazıcıoğlu L. Comparison of early-late results and cost effectivity of open surgical treatment and endovascular interventions in abdominal aortic aneurysms. CMJ. July 2021;43(2):167-176. doi:10.7197/cmj.912685