Rami O. Tadros, Peter L. Faries, Sharif H. Ellozy, Rachel Schrier, Sung yup Kim, Rajesh Malik, Ageliki G. Vouyouka, Robert A. Lookstein, Michael L. Marin
Vascular Surgery, The Mount Sinai Medical Center, New York, NY.
OBJECTIVES: There have been three eras in the development of EVAR: physician-made and early industry devices, intermediary commercial endografts and modern stentgrafts. This study analyzed the differences in outcomes between these three groups.
METHODS: From 1992-2012, 1,290 patients underwent elective EVAR. Fifteen different devices were used during this time. The three eras were defined as: Era 1: 1992-96; Era 2: 1997-2006; Era 3: 2007-2012. Grafts used in each era were: Era 1: physician-made and EVT; Era 2: Talent, AneuRx, Excluder, Quantum LP, Zenith, Vagaurd, PG AAA, Ancure, Endologix and TERAMed; Era 3: Talent, AneuRx, Endurant, Excluder, Zenith and Aptus.
RESULTS: Mean age was 75.2 years and 85% were men. First-generation patients were higher surgical risk (Mean Glasgow Aneurysm Scores: Era 1 84.81 vs. Era 3: 79.95, p=0.048). Adjunctive procedures increased from Era 1 to Era 3 (p=0.014). Procedure times (p<0.001), blood loss (p=0.01) and length of stay (p<0.001) have declined overtime. Major perioperative complications (Era 1: 23%, Era 2: 9.2%, and Era 3: 4.5%; p<0.001) and AAA-related perioperative mortality (Era 1: 17.6%, Era 2: 2.3%, and Era 3: 0.0%; p<0.001) have decreased. Type 1 and 3 endoleaks (p=0.011) and the need for re-intervention (p<0.001) have diminished. Median survival for all causes of death and freedom from aneurysm-related mortality significantly improved (Figure 1).
CONCLUSIONS: EVAR has evolved throughout the last 20 years resulting in an overall improvement in efficiency, outcomes and procedural success.
AUTHOR DISCLOSURES: S. H. Ellozy: Nothing to disclose; P. L. Faries: Nothing to disclose; S. Kim: Nothing to disclose; R. A. Lookstein: Nothing to disclose; R. Malik: Nothing to disclose; M. L. Marin: Nothing to disclose; R. Schrier: Nothing to disclose; R. O. Tadros: Nothing to disclose; A. G. Vouyouka: Nothing to disclose.
Posed April 2013