Endovascular abdominal aortic aneurysm repair by interventional cardiologists--a community-based experience.
BACKGROUND
Endovascular repair of abdominal aortic aneurysm (AAA) is a relatively recent technology. In comparison to the conventional open surgical treatment for AAA, endovascular AAA repair (EVAR) combines a less-invasive approach with lower morbidity and mortality. There have been few studies regarding the performance of this procedure in a community-based setting. We report our experience of EVAR performed primarily by interventional cardiologists in a community hospital.


METHODS
In our community hospital setting, between September 2005 and November 2007, we included all patients who underwent EVAR by interventional cardiologists, with available on-site vascular surgical support. Clinical and serial computed angiographic imaging outcomes were followed by a retrospective chart review. Data collection tools included demographic and clinical characteristics, anatomical aneurysm features, length of stay, peri- and postprocedural complications, and mortality.


RESULTS
A total of 71 consecutive patients had EVAR attempted. The endovascular stent placement was successful in 67 (93%) patients. Thirty-day mortality in this study was 1 of 71 (1.4%). All four procedural failures and the single periprocedural mortality occurred in women. Mean follow-up was 12 months. There were a total of six mortalities and among these four were women (P ≤ 0.001); however, multivariate analysis revealed loss of significant difference in mortality (P = 0.16). Major complications following EVAR were noted in 10 of 71 (14%) patients.


CONCLUSIONS
EVAR can be successfully performed by experienced interventional cardiologists with vascular surgical support in a community-based setting. In our experience, there is acceptable rate of complications and mortality in a carefully selected patient population.
Basoor
Abhijeet
A
Department of Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Michigan 48341, USA. drasbasoor@hotmail.com
Patel
Kiritkumar C
KC
Cotant
John F
JF
Halabi
Abdul R
AR
Todorov
Mina
M
Chughtai
Haroon
H
Choksi
Nishit
N
Diaczok
Benjamin
B
Zonia
Susan
S
Degregorio
Michele
M
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002309:Cardiology / Q000639:trends*; D003625:Data Collection; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents