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EVAR associated with fewer reoperations vs. open AAA repair
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Compared with open repair, endovascular aneurysm repair was associated with a lower risk for reoperation in veterans with abdominal aortic aneurysm, according to study findings.
Researchers conducted a retrospective review of data from the Veterans Affairs Surgical Quality Improvement Project, including 6,677 patients (99% men) who had AAA repair between October 2007 and October 2013.
The primary outcome was incidence of reoperation, defined as subsequent open-repair or EVAR procedure on the abdominal aorta or iliac arteries, surgical treatment of related bowel obstruction, treatment of abdominal or groin wound complications within 6 months and treatment of bowel or lower limb ischemia within 10 days.
The EVAR group was older than the open-repair group (71 years vs. 68 years; P < .01).
Among the cohort, 7.1% required a reoperation during the study period, Conor F. Hynes, MD, from the division of vascular surgery at Veterans Affairs Medical Center, Washington, D.C., and colleagues reported.
Those who had open repair had a higher rate of reoperation than those who had EVAR (10% vs. 6.3%; P < .01), with most reoperations due to wound complications or intra-abdominal issues, according to the researchers.
Compared with EVAR, open repair was also associated with higher rates of bowel ischemia necessitating reoperation (0.7% vs. 0.3%; P = .01) and lower extremity ischemia (0.5% vs. 0.06%; P < .01), they wrote.
Logistic regression analysis showed EVAR was a negative predictor for reoperation after adjustment for comorbidities (P < .001).
“The long-term burdens of reoperation after [open repair] may actually be more significant than current understanding when including all possible abdominal complications in an extended analysis,” Hynes and colleagues wrote. “As surgical innovation in EVAR technology advances, complication comparisons with [open repair] should undergo frequent re-evaluation given that endovascular indications and outcomes continue to expand and improve.” – by Erik Swain
Disclosure : The researchers report no relevant financial disclosures.
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