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Endovascular aneurysm repair outcomes improved over time
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Advances in endovascular aneurysm repair technology may have yielded improvements in a number of outcomes, including all-cause perioperative mortality, new research suggests.
The current analysis was an investigation of the four eras in the development of endovascular aneurysm repair: physician-made grafts, early industry devices, intermediary commercial endografts and modern stent grafts. The researchers evaluated the effect of evolution among the devices and increases in experience among physicians.
The analysis included 1,380 patients who underwent elective endovascular aneurysm repair using 14 different devices between 1992 and 2012.
The researchers used four generations of devices: Era 1 included all physician-made devices; era 2 ran from June 1994 to June 2003; era 3 ran from June 2003 to January 2008; and era 4 ran from January 2008 to July 2012.
Grafts in the second era included early industry devices such as Endovascular Technologies (EVT), Talent (Medtronic), Ancure (Guidant), AAAdvantage (AneuRx), Excluder (Gore), Quantum LP (Cordis), Vanguard (Boston Scientific) and Teramed (Ariba). Those in the third era included Talent, Powerlink (Endologix), Excluder, AAAdvantage, Zenith (Cook) and Aptus Endovascular. And for the fourth era, they were Endurant (Medtronic), Excluder and Zenith.
Baseline data indicated a mean patient age of 75.2 years and a cohort that was 84.5% men.
A decrease in adjunctive procedures was reported between era 1 and 2 (P<.001). However, these procedures increased in eras 3 and 4 (P<.001).
Compared with era 1, the researchers reported decreases in procedure times (P<.001), blood loss (P<.001) and length of stay (P<.001) in the latter three eras.
The rate of perioperative complications also decreased over time, from 23% in the first era to 5.9% in the second, 4.9% in the third and 4.7% in the fourth (P<.001).
Mortality associated with abdominal aortic aneurysm also decreased, from 4.3% in era 1 to 0.2% in era 2, 0.06% in era 3 and 0.5% in era 4 (P<.001).
All-cause perioperative mortality decreased over time as well (era 1, 7.7%; era 2, 1.9%; era 3, 1.5%; and era 4, 0.47%; P<.001).
Decreases were also reported with regard to type I and type III endoleaks (P<.001) and the need for reintervention (P<.001). The researchers reported a significant improvement in freedom from aneurysm-related mortality (P=.0005).
“[Endovascular aneurysm repair] has evolved during the last 20 years, resulting in an improvement in efficiency, outcomes and procedural success,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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