Albeir Mousa, Michael Parmely, Mike Broce, Shadi Abu Halimah, Patrick Stone, Stephen Hass, Aravinda Nanjundappa, John Campbell, Mark Bates, Ali AbuRahma
Vascular & Endovascular Surgery Division, University of West Virginia, Charleston, WV.
OBJECTIVES: To determine predictors of conversion from percutaneous (PEVAR) to an open approach (OEVAR) during groin access of endovascular aortic aneurysm repair (EVAR).
METHODS: A retrospective review of all EVAR patients from January 2009 through June 2011. Target vessels were classified as mild (<⅓), moderate (⅓ to ½) or severe (> ½) according to circumference of calcification.
RESULTS: We investigated 400 access sites for 200 patients who underwent EVAR. Averages were age 72.8+9.0, vessel size 9.6+1.8, sheath size 17.1+3.0, BMI 27.6+5.3 and eGFR 68.5+24.2%. Co-morbidities included dyslipidemia (64.5%) and hypertension (42%). There were 132 OEVAR (66 patients), 2 mixed (OEVAR and PEVAR for 1 patient) and 266 (133 patients) PEVAR approaches. Use of PEVAR increased over time [45.5% (2009), 77.8% (2010) and up to 88.5% (2011); p=0.001] while conversion decreased [24.3% (2009), 8.7% (2010) and 4.3% (2011); p=0.001]. Length of stay was significantly shorter for PEVAR (3.0+4.6 vs. 6.1+9.1 days; p=0.013). For the 266 PEVAR approaches, 32 (32/266=12%) had to be converted. After multivariate analysis, it was found that severely calcified arteries were most predictive of conversion (Odds Ratio (OR): 36.4, p<0.001). Year of procedure (2010; OR: 0.17, p=0.001), (2011; OR: 0.20, p=0.049), female gender (OR: 3.1, p=0.017), moderately calcified arteries (OR: 2.5, p=0.085) and age (OR: 2.3 (per decade), p=0.002) were all also significant. Vessel and sheath size along with BMI were non-significant.
CONCLUSIONS: PEVAR was found to be safe, reliable and feasible. Several factors, including vessel calcification, age and female gender should be considered before PEVAR intervention.
AUTHOR DISCLOSURES: S. Abu Halimah: Nothing to disclose; A. AbuRahma: Nothing to disclose; M. Bates: Nothing to disclose; M. Broce: Nothing to disclose; J. Campbell: Nothing to disclose; S. Hass: Nothing to disclose; A. Mousa: Nothing to disclose; A. Nanjundappa: Nothing to disclose; M. Parmely: Nothing to disclose; P. Stone: Nothing to disclose.
Posted April 2013