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1. Association of Hospital Volume with Perioperative Mortality of Endovascular Repair of Complex Aortic Aneurysms: A Nationwide Cohort Study

Author

Alberga, Anna J., von Meijenfeldt, Gerdine C. I., Rastogi, Vinamr, de Bruin, Jorg L., Wever, Jan J., van Herwaarden, Joost A., Hamming, Jaap F., Hazenberg, Constantijn E. V. B., van Schaik, Jan, Mees, Barend M. E., van der Laan, Maarten J., Zeebregts, Clark J., Schurink, Geert W. H., Verhagen, Hence J. M., van den Akker, P. J., Akkersdijk, G. P., Akkersdijk, W. L., van Andringa de Kempenaer, M. G., Arts, C. H. P., Avontuur, A. M., Bakker, O. J., Balm, R., Barendregt, W. B., Bekken, J. A., Bender, M. H. M., Bendermacher, B. L. W., van den Berg, M., Beuk, R. J., Blankensteijn, J. D., Bode, A. S., Bodegom, M. E., van der Bogt, K. E. A., Boll, A. P. M., Booster, M. H., Borger van der Burg, B. L. S., de Borst, G. J., Bos-van Rossum, W. T. G. J., Bosma, J., Botman, J. M. J., Bouwman, L. H., Brehm, V., de Bruijn, M. T., de Bruin, J. L., Brummel, P., van Brussel, J. P., Buijk, S. E., Buimer, M. G., Buscher, H. C. J. L., Cancrinus, E., Castenmiller, P. H., Cazander, G., Cuypers, P. W. M., Daemen, J. H. C., Dawson, I., Dierikx, J. E., Dijkstra, M. L., Diks, J., Dinkelman, M. K., Dirven, M., Dolmans, D. E. J. G. J., van Dortmont, L. M. C., Drouven, J. W., van der Eb, M. M., Eefting, D., van Eijck, G. J. W. M., Elshof, J. W. M., Elsman, A. H. P., van der Elst, A., van Engeland, M. I. A., van Eps, G. S., Faber, M. J., de Fijter, W. M., Fioole, B., Fritschy, W. M., Fung Kon Jin, P. H. P., Geelkerken, R. H., van Gent, W. B., Glade, G. J., Govaert, B., Groenendijk, R. P. R., de Groot, H. G. W., van den Haak, R. F. F., de Haan, E. F. A., Hajer, G. F., Hamming, J. F., van Hattum, E. S., Hazenberg, C. E. V. B., Hedeman Joosten, P. P. A., Helleman, J. N., van der Hem, L. G., Hendriks, J. M., van Herwaarden, J. A., Heyligers, J. M. M., Hinnen, J. W., Hissink, R. J., Ho, G. H., den Hoed, P. T., Hoedt, M. T. C., van Hoek, F., Hoencamp, R., Hoffmann, W. H., Hoksbergen, A. W. J., Hollander, E. J. F., Huisman, L. C., Hulsebos, R. G., Huntjens, K. M. B., Idu, M. M., Jacobs, M. J. H. M., van der Jagt, M. F. P., Jansbeken, J. R. H., Janssen, R. J. L., Jiang, H. H. L., de Jong, S. C., Jongbloed-Winkel, T. A., Jongkind, V., Kapma, M. R., Keller, B. P. J. A., Jahrome, A. Khodadade, Kievit, J. K., Klemm, P. L., Klinkert, P., Koedam, N. A., Koelemaij, M. J. W., Kolkert, J. L. P., Koning, G. G., Koning, O. H. J., Konings, R., Krasznai, A. G., Kropman, R. H. J., Kruse, R. R., van der Laan, L., van der Laan, M. J., van Laanen, J. H. H., van Lammeren, G. W., Lamprou, D. A. A., Lardenoije, J. H. P., Lauret, G. J., Leenders, B. J. M., Legemate, D. A., Leij-Dekkers, V. J., Lemson, M. S., Lensvelt, M. M. A., Lijkwan, M. A., van der Linden, F. T. P. M., Lung, P. F. L., Loos, M. J. A., Loubert, M. C., van de Luijtgaarden, K. M., Mahmoud, D. E. A. K., Manshanden, C. G., Mat-Tens, E. C. J. L., Meerwaldt, R., Mees, B. M. E., Menting, T. P., Metz, R., de Mol van Otterloo, J. C. A., Molegraaf, M. J., Montauban van Swijn-Dregt, Y. C. A., Morak, M. J. M., van de Mortel, R. H. W., Mulder, W., Nagesser, S. K., Naves, C. C. L. M., Nederhoed, J. H., Nevenzel, A. M., de Nie, A. J., Nieuwenhuis, D. H., van Nieuwenhuizen, R. C., Nieuwenhui-Zen, J., Nio, D., Oomen, A. P. A., Oranen, B. I., Oskam, J., Palamba, H. W., Peppelenbosch, A. G., van Petersen, A. S., Petri, B. J., Pierie, M. E. N., Ploeg, A. J., Pol, R. A., Ponfoort, E. D., Poyck, P. P. C., Prent, A., ten Raa, S., Raymakers, J. T. F. J., Reichmann, B. L., Reijnen, M. M. P. J., de Ridder, J. A. M., Rijbroek, A., van Rijn, M. J. E., de Roo, R. A., Rouwet, E. V., Saleem, B. R., van Sambeek, M. R. H. M., Samyn, M. G., van't Sant, H. P., van Schaik, J., van Schaik, P. M., Scharn, D. M., Scheltinga, M. R. M., Schepers, A., Schlejen, P. M., Schlösser, F. J. V., Schol, F. P. G., Scholtes, V. P. W., Schouten, O., Schreve, M. A., Schurink, G. W. H., Sikkink, C. J. J. M., te Slaa, A., Smeets, H. J., Smeets, L., Smeets, R. R., de Smet, A. A. E. A., Smit, P. C., Smits, T. M., Snoeijs, M. G. J., Sondakh, A. O., Speijers, M. J., van der Steenhoven, T. J., van Sterkenburg, S. M. M., Stigter, D. A. A., Stokmans, R. A., Strating, R. P., Stultiëns, G. N. M., Sybrandy, J. E. M., Teijink, J. A. W., Telgenkamp, B. J., Testroote, M. J. G., Tha-in, T., The, R. M., Thijsse, W. J., Thomassen, I., Tielliu, I. F. J., van Tongeren, R. B. M., Toorop, R. J., Tournoij, E., Truijers, M., Türkcan, K., Nolthenius, R. P. Tutein, Ünlü, C., Vaes, R. H. D., Vahl, A. C., Veen, E. J., Veger, H. T. C., Veldman, M. G., Verhagen, H. J. M., Verhoeven, B. A. N., Vermeulen, C. F. W., Vermeulen, E. G. J., Vierhout, B. P., van der Vijver-Coppen, R. J., Visser, M. J. T., van der Vliet, J. A., van Vlijmen-van Keulen, C. J., van der Vorst, J. R., Vos, A. W. F., Vos, C. G., Vos, G. A., de Vos, B., Voûte, M. T., Vriens, B. H. R., Vriens, P. W. H. E., de Vries, D. K., de Vries, J. P. P. M., de Vries, M., de Vries, A. C., van der Waal, C., Waasdorp, E. J., de Vries, B. M. Wallis, van Walraven, L. A., van Wanroi, J. L., Warlé, M. C., van Weel, V., van Well, A. M. E., Welten, G. M. J. M., Wever, J. J., Wiersema, A. M., Wikkeling, O. R. M., Willaert, W. I. M., Wille, J., Willems, M. C. M., Willigendael, E. M., Wilschut, E. D., Wisselink, W., Witte, M. E., Wittens, C. H. A., Wong, C. Y., Yazar, O., Yeung, K. K., Zeebregts, C. J. A. M., van Zeeland, M. L. P., Physiology, ACS - Pulmonary hypertension & thrombosis, Surgery, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, VU University medical center, AII - Inflammatory diseases, APH - Digital Health, Medical Biochemistry, ACS - Diabetes & metabolism, AII - Infectious diseases, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
volume-outcome, complex AAA, endovascular, mortality
Abstract

Objective: We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR. Summary of Background Data: Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volumeoutcome association exists in endovascular treatment of complex AAs (complex EVAR). Methods: All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories. Results: We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed

Published
2023
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2. Treatment Outcome Trends for Non-Ruptured Abdominal Aortic Aneurysms: A Nationwide Prospective Cohort Study

Author

Alberga, Anna J., Karthaus, Eleonora G., Wilschut, Janneke A., de Bruin, Jorg L., Akkersdijk, George P., Geelkerken, Robert H., Hamming, Jaap F., Wever, Jan J., Verhagen, Hence J. M., van den Akker, P. J., Akkersdijk, G. P., Akkersdijk, W. L., van Andringa de Kempenaer, M. G., Arts, C. H. P., Avontuur, A. M., Bakker, O. J., Balm, R., Barendregt, W. B., Bekken, J. A., Bender, M. H. M., Bendermacher, B. L. W., van den Berg, M., Beuk, R. J., Blankensteijn, J. D., Bode, A. S., Bodegom, M. E., van der Bogt, K. E. A., Boll, A. P. M., Booster, M. H., Borger van der Burg, B. L. S., de Borst, G. J., Bos-van Rossum, W. T. G. J., Bosma, J., Botman, J. M. J., Bouwman, L. H., Brehm, V., de Bruijn, M. T., de Bruin, J. L., Brummel, P., van Brussel, J. P., Buijk, S. E., Buimer, M. G., Buscher, H. C. J. L., Cancrinus, E., Castenmiller, P. H., Cazander, G., Cuypers, P. H. W. M., Daemen, J. H. C., Dawson, I., Dierikx, J. E., Dijkstra, M. L., Diks, J., Dinkelman, M. K., Dirven, M., Dolmans, D. E. J. G. J., van Dortmont, L. M. C., Drouven, J. W., van der Eb, M. M., Eefting, D., van Eijck, G. J. W. M., Elshof, J. W. M., Elsman, B. H. P., van der Elst, A., van Engeland, M. I. A., van Eps, G. S., Faber, M. J., de Fijter, W. M., Fioole, B., Fritschy, W. M., Jin, P. H. P. F. K., Geelkerken, R. H., van Gent, W. B., Glade, G. J., Govaert, B., Groenendijk, R. P. R., de Groot, H. G. W., van den Haak, R. F. F., de Haan, E. F. A., Hajer, G. F., Hamming, J. F., van Hattum, E. S., Hazenberg, C. E. V. B., Hedeman Joosten, P. P. H. A., Helleman, J. N., van der Hem, L. G., Hendriks, J. M., van Herwaarden, J. A., Heyligers, J. M. M., Hinnen, J. W., Hissink, R. J., Ho, G. H., den Hoed, P. T., Hoedt, M. T. C., van Hoek, F., Hoencamp, R., Hoffmann, W. H., Hoksbergen, A. W. J., Hollander, E. J. F., Huisman, L. C., Hulsebos, R. G., Huntjens, K. M. B., Idu, M. M., Jacobs, M. J. H. M., van der Jagt, M. F. P., Jansbeken, J. R. H., Janssen, R. J. L., Jiang, H. H. L., de Jong, S. C., Jongbloed-Winkel, T. A., Jongkind, V., Kapma, M. R., Keller, B. P. J. A., Jahrome, A. K., Kievit, J. K., Klemm, P. L., Klinkert, P., Koedam, N. A., Koelemaij, M. J. W., Kolkert, J. L. P., Koning, G. G., Koning, O. H. J., Konings, R., Krasznai, A. G., Kropman, R. H. J., Kruse, R. R., van der Laan, L., van der Laan, M. J., van Laanen, J. H. H., van Lammeren, G. W., Lamprou, D. A. A., Lardenoije, J. H. P., Lauret, G. J., Leenders, B. J. M., Legemate, D. A., Leijdekkers, V. J., Lemson, M. S., Lensvelt, M. M. A., Lijkwan, M. A., van der Linden, F. T. H. P. M., Lung, P. F. Liqui, Loos, M. J. A., Loubert, M. C., van de Luijtgaarden, K. M., Mahmoud, D. E. A. K., Manshanden, C. G., Mattens, E. C. J. L., Meerwaldt, R., Mees, B. M. E., Menting, T. P., Metz, R., de Mol van Otterloo, J. C. A., Molegraaf, M. J., Montauban van Swijndregt, Y. C. A., Morak, M. J. M., van de Mortel, R. H. W., Mulder, W., Nagesser, S. K., Naves, C. C. L. M., Nederhoed, J. H., Nevenzel, A. M., de Nie, A. J., Nieuwenhuis, D. H., van Nieuwenhuizen, R. C., Nieuwenhuizen, J., Nio, D., Oomen, A. P. A., Oranen, B. I., Oskam, J., Palamba, H. W., Peppelenbosch, A. G., van Petersen, A. S., Petri, B. J., Pierie, M. E. N., Ploeg, A. J., Pol, R. A., Ponfoort, E. D., Poyck, P. P. C., Prent, A., Raa, S. ten, Raymakers, J. T. F. J., Reichmann, B. L., Reijnen, M. M. P. J., de Ridder, J. A. M., Rijbroek, A., van Rijn, M. J. E., de Roo, R. A., Rouwet, E. V., Saleem, B. R., van Sambeek, M. R. H. M., Samyn, M. G., van ’t Sant, H. P., van Schaik, J., van Schaik, P. M., Scharn, D. M., Scheltinga, M. R. M., Schepers, A., Schlejen, P. M., Schlösser, F. J. V., Schol, F. P. G., Scholtes, V. P. W., Schouten, O., Schreve, M. A., Schurink, G. W. H., Sikkink, C. J. J. M., Slaa, A. te, Smeets, H. J., Smeets, L., Smeets, R. R., de Smet, A. A. E. A., Smit, P. C., Smits, T. M., Snoeijs, M. G. J., Sondakh, A. O., Speijers, M. J., van der Steenhoven, T. J., van Sterkenburg, S. M. M., Stigter, D. A. A., Stokmans, R. A., Strating, R. P., Stultiëns, G. N. M., Sybrandy, J. E. M., Teijink, J. A. W., Telgenkamp, B. J., Testroote, M. J. G., Tha-in, T., The, R. M., Thijsse, W. J., Thomassen, I., Tielliu, I. F. J., van Tongeren, R. B. M., Toorop, R. J., Tournoij, E., Truijers, M., Türkcan, K., Tutein Nolthenius, R. P., Ünlü, C., Vaes, R. H. D., Vahl, A. C., Veen, E. J., Veger, H. T. C., Veldman, M. G., Verhagen, H. J. M., Verhoeven, B. A. N., Vermeulen, C. F. W., Vermeulen, E. G. J., Vierhout, B. P., van der Vijver-Coppen, R. J., Visser, M. J. T., van der Vliet, J. A., van Vlijmen - van Keulen, C. J., van der Vorst, J. R., Vos, A. W. F., Vos, C. G., Vos, G. A., de Vos, B., Voûte, M. T., Vriens, B. H. R., Vriens, P. W. H. E., de Vries, D. K., de Vries, J. P. P. M., de Vries, M., de Vries, A. C., van der Waal, C., Waasdorp, E. J., Wallis de Vries, B. M., van Walraven, L. A., van Wanroi, J. L., Warlé, M. C., van Weel, V., van Well, A. M. E., Welten, G. M. J. M., Wever, J. J., Wiersema, A. M., Wikkeling, O. R. M., Willaert, W. I. M., Wille, J., Willems, M. C. M., Willigendael, E. M., Wilschut, E. D., Wisselink, W., Witte, M. E., Wittens, C. H. A., Wong, C. Y., Yazar, O., Yeung, K. K., Zeebregts, C. J. A. M., van Zeeland, M. L. P., ACS - Microcirculation, Anesthesiology, Physiology, ACS - Pulmonary hypertension & thrombosis, Surgery, ACS - Atherosclerosis & ischemic syndromes, VU University medical center, ACS - Diabetes & metabolism, TechMed Centre, Multi-Modality Medical Imaging, Medical Biochemistry, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
Male, Time Factors, Operative procedure, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Risk Assessment, Blood Vessel Prosthesis Implantation, Postoperative Complications, Risk Factors, Humans, Hospital Mortality, Prospective Studies, Registries, Treatment outcome, Aged, Netherlands, Retrospective Studies, Aged, 80 and over, Endovascular Procedures, Quality of care, Middle Aged, Endovascular procedure, Abdominal aortic aneurysm, Surgery, Female, Trends, Cardiology and Cardiovascular Medicine, Aortic Aneurysm, Abdominal
Abstract

Contains fulltext : 251573.pdf (Publisher’s version ) (Open Access) OBJECTIVE: The Dutch Surgical Aneurysm Audit (DSAA) initiative was established in 2013 to monitor and improve nationwide outcomes of aortic aneurysm surgery. The objective of this study was to examine whether outcomes of surgery for intact abdominal aortic aneurysms (iAAA) have improved over time. METHODS: Patients who underwent primary repair of an iAAA by standard endovascular (EVAR) or open surgical repair (OSR) between 2014 and 2019 were selected from the DSAA for inclusion. The primary outcome was peri-operative mortality trend per year, stratified by OSR and EVAR. Secondary outcomes were trends per year in major complications, textbook outcome (TbO), and characteristics of treated patients. The trends per year were evaluated and reported in odds ratios per year. RESULTS: In this study, 11 624 patients (74.8%) underwent EVAR and 3 908 patients (25.2%) underwent OSR. For EVAR, after adjustment for confounding factors, there was no improvement in peri-operative mortality (aOR [adjusted odds ratio] 1.06, 95% CI 0.94 - 1.20), while major complications decreased (2014: 10.1%, 2019: 7.0%; aOR 0.91, 95% CI 0.88 - 0.95) and the TbO rate increased (2014: 68.1%, 2019: 80.9%; aOR 1.13, 95% CI 1.10 - 1.16). For OSR, the peri-operative mortality decreased (2014: 6.1%, 2019: 4.6%; aOR 0.89, 95% CI 0.82 - 0.98), as well as major complications (2014: 28.6%, 2019: 23.3%; aOR 0.95, 95% CI 0.91 - 0.99). Furthermore, the proportion of TbO increased (2014: 49.1%, 2019: 58.3%; aOR 1.05, 95% CI 1.01 - 1.10). In both the EVAR and OSR group, the proportion of patients with cardiac comorbidity increased. CONCLUSION: Since the establishment of this nationwide quality improvement initiative (DSAA), all outcomes of iAAA repair following EVAR and OSR have improved, except for peri-operative mortality following EVAR which remained unchanged.

Published
2022
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3. Editor's Choice - Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands.

Author

Jalalzadeh H, Indrakusuma R, Koelemay MJW, Balm R, Van den Akker LH, Van den Akker PJ, Akkersdijk GJ, Akkersdijk GP, Akkersdijk WL, van Andringa de Kempenaer MG, Arts CH, Avontuur JA, Baal JG, Bakker OJ, Balm R, Barendregt WB, Bender MH, Bendermacher BL, van den Berg M, Berger P, Beuk RJ, Blankensteijn JD, Bleker RJ, Bockel JH, Bodegom ME, Bogt KE, Boll AP, Booster MH, Borger van der Burg BL, de Borst GJ, Bos-van Rossum WT, Bosma J, Botman JM, Bouwman LH, Breek JC, Brehm V, Brinckman MJ, van den Broek TH, Brom HL, de Bruijn MT, de Bruin JL, Brummel P, van Brussel JP, Buijk SE, Buimer MG, Burger DH, Buscher HC, den Butter G, Cancrinus E, Castenmiller PH, Cazander G, Coveliers HM, Cuypers PH, Daemen JH, Dawson I, Derom AF, Dijkema AR, Diks J, Dinkelman MK, Dirven M, Dolmans DE, van Doorn RC, van Dortmont LM, van der Eb MM, Eefting D, van Eijck GJ, Elshof JW, Elsman BH, van der Elst A, van Engeland MI, van Eps RG, Faber MJ, de Fijter WM, Fioole B, Fritschy WM, Geelkerken RH, van Gent WB, Glade GJ, Govaert B, Groenendijk RP, de Groot HG, van den Haak RF, de Haan EF, Hajer GF, Hamming JF, van Hattum ES, Hazenberg CE, Hedeman Joosten PP, Helleman JN, van der Hem LG, Hendriks JM, van Herwaarden JA, Heyligers JM, Hinnen JW, Hissink RJ, Ho GH, den Hoed PT, Hoedt MT, van Hoek F, Hoencamp R, Hoffmann WH, Hoksbergen AW, Hollander EJ, Huisman LC, Hulsebos RG, Huntjens KM, Idu MM, Jacobs MJ, van der Jagt MF, Jansbeken JR, Janssen RJ, Jiang HH, de Jong SC, Jongkind V, Kapma MR, Keller BP, Khodadade Jahrome A, Kievit JK, Klemm PL, Klinkert P, Knippenberg B, Koedam NA, Koelemay MJ, Kolkert JL, Koning GG, Koning OH, Krasznai AG, Krol RM, Kropman RH, Kruse RR, van der Laan L, van der Laan MJ, van Laanen JH, Lardenoye JH, Lawson JA, Legemate DA, Leijdekkers VJ, Lemson MS, Lensvelt MM, Lijkwan MA, Lind RC, van der Linden FT, Liqui Lung PF, Loos MJ, Loubert MC, Mahmoud DE, Manshanden CG, Mattens EC, Meerwaldt R, Mees BM, Metz R, Minnee RC, de Mol van Otterloo JC, Moll FL, Montauban van Swijndregt YC, Morak MJ, van de Mortel RH, Mulder W, Nagesser SK, Naves CC, Nederhoed JH, Nevenzel-Putters AM, de Nie AJ, Nieuwenhuis DH, Nieuwenhuizen J, van Nieuwenhuizen RC, Nio D, Oomen AP, Oranen BI, Oskam J, Palamba HW, Peppelenbosch AG, van Petersen AS, Peterson TF, Petri BJ, Pierie ME, Ploeg AJ, Pol RA, Ponfoort ED, Poyck PP, Prent A, Ten Raa S, Raymakers JT, Reichart M, Reichmann BL, Reijnen MM, Rijbroek A, van Rijn MJ, de Roo RA, Rouwet EV, Rupert CG, Saleem BR, van Sambeek MR, Samyn MG, van 't Sant HP, van Schaik J, van Schaik PM, Scharn DM, Scheltinga MR, Schepers A, Schlejen PM, Schlosser FJ, Schol FP, Schouten O, Schreinemacher MH, Schreve MA, Schurink GW, Sikkink CJ, Siroen MP, Te Slaa A, Smeets HJ, Smeets L, de Smet AA, de Smit P, Smit PC, Smits TM, Snoeijs MG, Sondakh AO, van der Steenhoven TJ, van Sterkenburg SM, Stigter DA, Stigter H, Strating RP, Stultiëns GN, Sybrandy JE, Teijink JA, Telgenkamp BJ, Testroote MJ, The RM, Thijsse WJ, Tielliu IF, van Tongeren RB, Toorop RJ, Tordoir JH, Tournoij E, Truijers M, Türkcan K, Tutein Nolthenius RP, Ünlü Ç, Vafi AA, Vahl AC, Veen EJ, Veger HT, Veldman MG, Verhagen HJ, Verhoeven BA, Vermeulen CF, Vermeulen EG, Vierhout BP, Visser MJ, van der Vliet JA, Vlijmen-van Keulen CJ, Voesten HG, Voorhoeve R, Vos AW, de Vos B, Vos GA, Vriens BH, Vriens PW, de Vries AC, de Vries JP, de Vries M, van der Waal C, Waasdorp EJ, Wallis de Vries BM, van Walraven LA, van Wanroij JL, Warlé MC, van Weel V, van Well AM, Welten GM, Welten RJ, Wever JJ, Wiersema AM, Wikkeling OR, Willaert WI, Wille J, Willems MC, Willigendael EM, Wisselink W, Witte ME, Wittens CH, Wolf-de Jonge IC, Yazar O, Zeebregts CJ, and van Zeeland ML

Subjects
Aged, Aged, 80 and over, Endovascular Procedures methods, Endovascular Procedures mortality, Endovascular Procedures statistics & numerical data, Female, Guideline Adherence statistics & numerical data, Humans, Iliac Aneurysm epidemiology, Iliac Aneurysm mortality, Iliac Aneurysm pathology, Iliac Artery pathology, Iliac Artery surgery, Male, Netherlands epidemiology, Registries, Retrospective Studies, Sex Factors, Treatment Outcome, Iliac Aneurysm surgery
Abstract

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR)., Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests., Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38-50) mm and 68 (IQR 58-85) mm, respectively. Mortality was 1.3% (95% CI 0.7-2.4) after eIAA repair and 25.5% (95% CI 18.0-34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively)., Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair., (Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Published
2020
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4. Mid-term survival and costs of treatment of patients with descending thoracic aortic aneurysms; endovascular vs. open repair: a case-control study.

Author

Glade GJ, Vahl AC, Wisselink W, Linsen MA, and Balm R

Subjects
Adult, Aged, Aged, 80 and over, Angioplasty mortality, Blood Vessel Prosthesis Implantation mortality, Case-Control Studies, Female, Health Care Costs, Humans, Male, Middle Aged, Retrospective Studies, Stents, Survival Analysis, Angioplasty economics, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation economics, Postoperative Complications
Abstract

Objectives: To evaluate the results of open surgery or endovascular stent graft repair of descending thoracic aortic aneurysm (TAA)., Design, Materials and Methods: This is a retrospective multicenter study of 95 patients undergoing TAA repair (42 stent grafts, 53 open repair). The median age was 67 years. Post-operative complications, mid-term survival and costs were assessed. The results were pooled with data in the literature., Results: After a mean follow up of 26 months (open group) and 15 months (endovascular group) survival was similar for patients treated by either repair method. Post-operative pneumonia was more in the open group (p <0.02). The hospital costs of open treatment were 40% more than that of the endovascular procedure. Combining the present results with pooled data from the literature the peri-operative mortality and paraplegia rate was less in the endovascular group (p <0.05)., Conclusions: These retrospective data suggest that endografting of descending thoracic aneurysms can be performed with less peri-operative morbidity, at lower hospital costs, but with equal mid-term life expectancy, compared with open grafting.

Published
2005
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