Vascular Web Logo

SVS  SVS Foundation
A A A
VascularWeb

 PS26. Vascular Surgeons Repair an Increasing Majority of Abdominal Aortic Aneurysms After the Introduction of EVAR

​Rob Hurks1, Rodney P. Bensley1, Ruby C. Lo1, Michael D. Howell1, George S. DaSilva1, Mark C. Wyers1, Allen D. Hamdan1, Frans L. Moll2, Marc L. Schermerhorn1
1Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; 2University Medical Center Utrecht, Utrecht, The Netherlands.

OBJECTIVES: Outcome after AAA repair relies on the experience of the treating physician. We sought to examine the impact of the introduction of EVAR on specialties performing AAA repair.

METHODS: The NIS was queried from 2001-2009 for intact and ruptured AAA and for EVAR and open repair (OAR). Specific procedures were used to identify cardiac (CS), general (GS) and vascular surgeons (VS) for states that reported unique treating physician identifiers. Annual surgeon and hospital volumes were calculated and reported in terciles.

RESULTS: We identified 193,668 AAA repairs. VS performed an increasing proportion of AAA repairs (44%->64%) driven by the increased utilization of EVAR (33%->78%), as VS currently perform 67%, GS 17% and CS 11%. In 2009 high volume VS in high and medium volume hospitals performed 25% and 45% of intact, and 14% and 40% of ruptured OAR and EVAR. For GS, most intact OAR were performed by low volume surgeons (LVS) in low volume hospitals (LVH). Median annual surgeon volume decreased for OAR (8->4) but increased for EVAR (9->12). Treatment by CS (0.89[0.86-0.92]), and in LVH (0.78[0.75-0.81]) decreased the likelihood of receiving EVAR.

CONCLUSIONS: VS perform an increasing majority of AAA repairs, driven by the increased utilization of EVAR. Although the majority of AAA repairs were performed by HVS in higher volume hospitals, median surgeon annual open repair volume halved. Surgeon and hospital volume, and MD specialty are associated with differing mortality rates and likelihood of receiving EVAR.

AUTHOR DISCLOSURES: R. P. Bensley, Nothing to disclose; G. S. DaSilva, Nothing to disclose; A. D. Hamdan, Nothing to disclose; M. D. Howell, Nothing to disclose; R. Hurks, Nothing to disclose; R. C. Lo, Nothing to disclose; F. L. Moll, Nothing to disclose; M. L. Schermerhorn, Nothing to disclose; M. C. Wyers, Nothing to disclose.

Open Repair
EVAR
LVH (<9)
HVH (>22)
LVH (<13)
HVH (>36)
LVS (<2)
HVS (>7)
LVS (<2)
HVS (>7)
LVS (<2)
HVS (>12)
LVS (<2)
HVS (>12)
VS
N
2275
591
706
12245
1565
709
541
25135
Mort
5.1
2.5
3.4
3.1
0.9
0.7
0
0.5
GS
N
2420
276
586
1909
1337
141
215
2102
Mort
5.1
3.6
8.2
3.8
2.6
0
2.3
0.7
CS
N
854
302
450
3295
469
150
182
2506
Mort
2.2
3.3
1.1
1.6
2.1
0
2.7
0.8
Total
Mort
4.7
3.0
4.4
2.9
1.8
0.5
1.1
0.6

Posted April 2012

Contact Us

Society for Vascular Surgery
633 North Saint Clair Street, 22nd Floor | Chicago, IL 60611
Phone: 312-334-2300 | 800-258-7188
Fax: 312-334-2320
Email: vascular@vascularsociety.org

Follow Us

YouTube

VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.