title: Endovascular abdominal aortic aneurysm repair outside a tertiary referral centre: feasibility and impact upon workload.
abstract: In the UK, the majority of endovascular abdominal aortic aneurysm repairs (EVAR) are carried out in tertiary referral centres. We studied the feasibility and impact upon workload of an endovascular programme introduced into a district general hospital. Data was collected prospectively on all patients considered for EVAR since the inception of the programme in April 1999. Evaluation was by contrast enhanced CT scan followed by angiography if potentially suitable for EVAR. We recorded eligibility for EVAR, reasons for exclusion and the outcome of all patients irrespective of the mode of repair. Ninety patients were assessed over a 26-month period, nine of which did not complete the evaluation process. Sixty patients had one or more morphological features that precluded EVAR. Twenty-one patients were eligible for EVAR (26%), of which eighteen proceeded to EVAR, one awaits EVAR and two were below the treatment threshold (<5.5 cm). Seventeen had successful aneurysm exclusion and one required immediate conversion. One patient died within 30 days from gastrointestinal haemorrhage. There was one type-II endoleak at 1 month and to date we have encountered no ruptures or aneurysm-related deaths. Of the remaining 60 patients, 29 have proceeded to elective and 8 to urgent open repair with 2 deaths within 30 days in each group. EVAR is feasible outside tertiary referral centres and satisfactory early results can be achieved. An endovascular programme has important implications upon radiological and surgical workload. The operative mortality of patients undergoing open aortic repair remains acceptable following the introduction of an endovascular service into a district general hospital.
authors.affiliation: Lancaster and Lake District Vascular Unit, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK. ckarkos@hotmail.com
authors.forename: Christos D
authors.initials: CD
authors.lastname: Karkos
authors.forename: Dale
authors.initials: D
authors.lastname: Vimalachandran
authors.forename: Janet M
authors.initials: JM
authors.lastname: Lavelle
authors.forename: Paul
authors.initials: P
authors.lastname: Wilson
authors.forename: John S
authors.initials: JS
authors.lastname: Abraham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D000075202:Contraindications; D004739:England; D005240:Feasibility Studies; D005260:Female; D006767:Hospitals, District / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D012041:Regional Medical Programs; D015607:Stents; D016896:Treatment Outcome; D016526:Workload