S M Thomas1, P A Gaines, J D Beard. 1. Sheffield Vascular Institute, Northern General Hospital, Herries Road, Sheffield S57AU, U.K.
Abstract
OBJECTIVES: to assess the early morbidity and mortality of a new treatment, the endovascular repair of abdominal aortic aneurysms, during its introduction into clinical practice. DESIGN: a prospective voluntary registry collecting demographic and risk factor data, details of aneurysm morphology, procedure performed, immediate and 30-day outcomes. SETTING: thirty-one U.K. centres performing endovascular repair submitted data. RESULTS: six hundred and eleven cases were registered in three years of data collection (January 1996 to December 1998). Four per cent of patients received an aortic tube device, 60% an aorto-bi-iliac device and 36% an aorto-uni-iliac device and a crossover graft (AUIC). Conversion to open repair was required in 5% of cases, with more conversions in the AUIC group (OR 2.9 (95% CI: 1.3-6.4)p=0.01). Post procedure complications occurred in 25% of cases. Unfit patients had significantly more complications than fit patients (35% vs 20% for fit patients (OR 1.8 (95% CI: 1.2-2.7)p=0.007)). At 30 days aneurysms were excluded in 90% of cases. Endoleaks were more common in larger aneurysms (2% if aneurysms were <6 cm in diameter vs 10% if >6 cm, OR 5.6 (95% CI: 2.1-14.9)p=0.0006). The overall mortality was 7% but was significantly higher for AUIC devices, (4% for combined aortic tube and bi-iliac devices (AT/BI) vs 12%, OR 2.6 (95% CI: 1.2-5.9 p=0.018)), and unfit patients (4% for fit patients vs 18%, OR 4.3 (95% CI: 2.0-9.5)p<0.001). CONCLUSIONS: endovascular repair is feasible with short-term outcomes comparable to those of conventional surgical repair. In unfit patients the possible benefit in life expectancy gain must be balanced against the morbidity and mortality of the procedure.
OBJECTIVES: to assess the early morbidity and mortality of a new treatment, the endovascular repair of abdominal aortic aneurysms, during its introduction into clinical practice. DESIGN: a prospective voluntary registry collecting demographic and risk factor data, details of aneurysm morphology, procedure performed, immediate and 30-day outcomes. SETTING: thirty-one U.K. centres performing endovascular repair submitted data. RESULTS: six hundred and eleven cases were registered in three years of data collection (January 1996 to December 1998). Four per cent of patients received an aortic tube device, 60% an aorto-bi-iliac device and 36% an aorto-uni-iliac device and a crossover graft (AUIC). Conversion to open repair was required in 5% of cases, with more conversions in the AUIC group (OR 2.9 (95% CI: 1.3-6.4)p=0.01). Post procedure complications occurred in 25% of cases. Unfit patients had significantly more complications than fit patients (35% vs 20% for fit patients (OR 1.8 (95% CI: 1.2-2.7)p=0.007)). At 30 days aneurysms were excluded in 90% of cases. Endoleaks were more common in larger aneurysms (2% if aneurysms were <6 cm in diameter vs 10% if >6 cm, OR 5.6 (95% CI: 2.1-14.9)p=0.0006). The overall mortality was 7% but was significantly higher for AUIC devices, (4% for combined aortic tube and bi-iliac devices (AT/BI) vs 12%, OR 2.6 (95% CI: 1.2-5.9 p=0.018)), and unfit patients (4% for fit patients vs 18%, OR 4.3 (95% CI: 2.0-9.5)p<0.001). CONCLUSIONS: endovascular repair is feasible with short-term outcomes comparable to those of conventional surgical repair. In unfit patients the possible benefit in life expectancy gain must be balanced against the morbidity and mortality of the procedure.