title: Endoluminal stent-graft placement for repair of abdominal aortic aneurysms in the community setting.
abstract: OBJECTIVE
  To demonstrate that results similar to high-volume academic centers can be achieved in the community setting when treating abdominal aortic aneurysm (AAA) using endovascular techniques, given appropriate volume and skill sets.
  
  
  METHODS
  A retrospective review was conducted of 342 consecutive patients who underwent endovascular aneurysm repair (EVAR) by surgeons in a community hospital group from October 1999 through September 2005. In this population, 245 (71.6%) patients were treated with EVAR and 97 (28.4%) with open surgical repair. Of the 245 EVAR patients (203 men; mean age 73.4+/-9.2 years), 218 AneuRx, 19 Ancure, 6 Excluder, and 2 Zenith stent-grafts were implanted by 2 vascular surgeons to exclude AAAs with a mean diameter of 54+/-11 mm. Patients were followed postoperatively with office visits and computed tomography at 1, 6, and 12 months and annually thereafter.
  
  
  RESULTS
  Technical success was achieved in 99.6% (244/245) with 1 intraoperative conversion. Mean operative time was 131+/-57 minutes, with a mean contrast load of 161.6+/-65.5 mL. Thirty-five (14.3%) patients required intraoperative blood transfusion. Length of stay was 2.3+/-4.5 days. Thirty-day mortality was 0.8% (2/245). Secondary procedures were required in 15 (6.1%) patients. Kaplan-Meier estimates of freedom from secondary interventions were 98%, 98%, 95%, and 90% at 12, 24, 36, and 48 months, respectively. At the same time points, freedom from surgical conversion was 99%, 99%, 97%, and 96%, and freedom from aneurysm-related death was 97%, 96%, 96%, and 96%.
  
  
  CONCLUSIONS
  Endovascular AAA repair provides a less invasive method of managing aortic disease with resultant low perioperative mortality. Results in our community hospital demonstrate that this technology can be applied outside an academic environment in nearly three quarters of the population with excellent short and long-term results.
authors.affiliation: Oregon Surgical Specialists, Medford, OR 97504, USA. dkttraul@hotmail.com
authors.forename: David
authors.initials: D
authors.lastname: Traul
authors.forename: David
authors.initials: D
authors.lastname: Street
authors.forename: William
authors.initials: W
authors.lastname: Faught
authors.forename: Mark
authors.initials: M
authors.lastname: Eaton
authors.forename: Juan
authors.initials: J
authors.lastname: Castillo
authors.forename: John
authors.initials: J
authors.lastname: Brawner
authors.forename: Lena
authors.initials: L
authors.lastname: Varner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001803:Blood Transfusion; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002983:Clinical Competence; D003153:Community Health Services; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009922:Oregon; D010043:Outcome and Process Assessment, Health Care; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016526:Workload