The impact of an interventional vascular specialty team on institutional endovascular aneurysm repair outcomes.
BACKGROUND
Endovascular aortic aneurysm repair (EVAR) is a technically demanding, resource-intensive procedure associated with a significant learning curve. In July 2002, the Department of Defense allocated nearly $5,000,000 for "Advances in Medical Practice" (AMP) and EVAR within the six major military medical centers in the United States Army. We sought to determine the impact of several institutional changes associated with the use of these funds.


METHODS
We performed a single-institution, retrospective comparison of our early EVAR outcomes in physiologically similar patients before and after the use of AMP capital and the acquisition of a trained and equipped endovascular operative team. Morbidity, mortality, and operative variables were the main outcomes. Mean follow-up interval was 17.6 months.


RESULTS
As of November 2004, a total of 114 conventional open and endovascular AAA repairs were performed at our institution since our first EVAR in May 2000. Ten of 51 (20%) total AAA patients were treated with EVAR by a general vascular surgical team before the addition of an endovascular specialty team to the service in July 2002. An additional 28 of 63 (44%) patients have been treated with EVAR since that time for a total of 38 repairs. During the first year evaluated, 20% of aneurysms were repaired with EVAR versus 83% during the most recent year. Devices from four different manufacturers were used during the study interval. Patients treated by the endovascular team had significantly less mean estimated blood loss (EBL), packed red blood cells (PRBCs) transfused, intravenous (IV) contrast used, and shorter operative times. Morbidity, mortality, endoleaks, and other variables were similar. In linear regression analysis adjusting for complex, time-consuming repairs that required adjunctive procedures outside the realm of normal EVAR, endovascular team EVAR was independently associated with decreased mean operative time, EBL, PRBCs transfused, and IV contrast used.


CONCLUSIONS
At a major military medical center, EVAR has become the preferred technique for the repair of abdominal aortic aneurysms. EVAR by a dedicated endovascular surgical team favorably impacts several important operative variables and may improve overall outcomes. Some of these operative variables may be device specific.
Mullenix
Philip S
PS
General Surgery Service, Madigan Army Medical Center, Tacoma, WA, USA.
Starnes
Benjamin W
BW
Ronsivalle
Joseph A
JA
Andersen
Charles A
CA
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D006801:Humans; D016014:Linear Models; D008887:Military Medicine; D010348:Patient Care Team / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000379:methods*