Impact of Endovascular Repair (EV) on Management of Visceral Artery Aneurysms (VAA)
Samuel M. Miller1, Brandon J. Sumpio2, Alfredo Cordova1, Bauer E. Sumpio2.
1Warren Alpert Medical School of Brown University, Providence, RI, USA, 2Department of Vascular Surgery, Yale University School of Medicine, New Haven, CT, USA.
EV repair of VAA has become more widespread. The purpose of this study was to evaluate the outcomes of EV and open repair of VAA.
Patients with a primary diagnosis of VAA (splenic (SAA) and non-splenic visceral artery aneurysms), excluding those with concomitant aortic pathology, were identified from the Nationwide Inpatient Sample between 2003 and 2012. Demographics, comorbidities, complications and surgical outcomes of patients treated with EV (coil or stent) or open repair or ligation were compared and analyzed by chi-squared tests of independence and independent-samples t-tests using SPSS 24 software. P<0.05 was considered statistically significant.
We identified 2561 VAA patients (1239 were SAA). The incidence of VAA steadily rose and the number of patients treated rose from 62.8% to 73.0% (p<0.05). Of the patients treated, those with endovascular repair rose from 26.8% in 2003 to 71.4% in 2012 (p<0.001) while those treated with open repair fell from 73.2% in 2003 to 28.6% in 2012 (p<0.001). Aside from differences in the incidence of dysrhythmias and chronic renal failure, the patients did not differ in comorbidities between treatment groups. Mortality was not different between EV (3.8%) and open repairs (4.7%). Patients with open repairs were more likely to experience postoperative complications (13.0%, wound and infections) than those with EV (9.7%, vascular complications). Length of stay (LOS) was shorter for patients with EV repair (6.6 days vs 9.68).
EV intervention of VAA has increased while open repair is being used less. Mortality rates were similar for EV and open repairs. Patients with EV repairs experienced fewer complications and stayed two days shorter in the hospital than those with open repairs, both of which may lead to decreased cost. With the increasing prevalence of VAA, the addition of an EV option may be increasing the number of patients with VAA that can be treated.
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