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Percutaneous access for EVAR in ruptured AAA safe, increasing in use
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Totally percutaneous access for endovascular repair of ruptured abdominal aortic aneurysms is growing in use and confers similar outcomes to endovascular aneurysm repair with femoral cutdown access, researchers reported.
Samuel L. Chen, MD, from the division of vascular and endovascular surgery, department of surgery, University of California, Irvine Medical Center, and colleagues analyzed 502 patients from the American College of Surgeons National Surgical Quality Improvement Program targeted vascular database who underwent EVAR for a ruptured aneurysm between 2011 and 2014.
The researchers compared demographics, operation-specific variables and clinical outcomes between the 25.7% of the cohort who had totally percutaneous EVAR and the 74.3% who had EVAR with femoral cutdown access.
During the study period, use of totally percutaneous EVAR rose from 14% to 32%, according to the researchers.
Among the population, 24% had bilateral percutaneous access, 2% were converted to surgical cutdown from percutaneous access, 64% had bilateral femoral cutdowns and 10% had a single femoral cutdown.
The groups did not differ in age, sex, BMI, AAA size or other high-risk physiologic comorbidities. They also did not differ in preoperative hemodynamic instability (percutaneous group, 48.1%; surgical group, 45%; P = .55) or need for perioperative transfusion (percutaneous group, 67.4%; surgical group, 67.8%; P = .94).
Regional anesthesia was more commonly used in totally percutaneous EVAR than in EVAR with femoral cutdown access (20.9% vs. 7.8%; P < .01), Chen and colleagues wrote.
Postoperative wound complication was similar between the groups (percutaneous group, 4.8%; surgical group, 5.4%; P = .79), but length of stay was shorter in the percutaneous group (mean difference, 1.3 days) while operative time was longer in the percutaneous group (mean difference, 6.3 minutes), according to the researchers.
Overall 30-day mortality was higher in the totally percutaneous EVAR group (28.7% vs. 20.1%; P = .04), but 30-day mortality in the totally percutaneous EVAR group declined from 38.2% in 2011-2012 to 25.3% in 2013-2014, as did operative time (188 minutes to 163 minutes), Chen and colleagues wrote.
However, after adjustment for age, sex, hypotension, need for perioperative transfusion, anesthesia type, need for concomitant procedure and aneurysm characteristics, there was no difference between the groups in 30-day mortality (OR = 1.5; 95% CI, 0.8-2.7).
“On initial comparison, the worse mortality in the percutaneous group was surprising,” Chen said in a press release. “However, after adjustment for various risk factors, we did not find statistically significant differences in mortality, operative time, rate of wound complications or hospital length of stay between the two groups. The primary outcomes of operative time and mortality significantly improved for the percutaneous group over the 4-year study period.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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