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 PS36. Significant Predictors of Open Surgical Conversion Following Failed Percutaneous Approach for Endovascular Aortic Aneurysm Repair

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

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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.