Adding an endovascular aortic surgery program to a rural regional medical centre.
BACKGROUND
Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program.


METHODS
A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring.


RESULTS
In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55-89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program.


CONCLUSIONS
Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable.
The Division of Cardiac Surgery, Bayhealth Medical Center, Dover, Deleware.
Daniel
D
Marelli
Edward
E
Woo
Michael
M
Watson
Paul
P
Fedalen
Grace
G
Wang
Megan
M
Stallings
Ronald
R
Fairman
John
J
Mannion
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D003406:Credentialing; D057867:Endoleak / Q000453:epidemiology; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D061847:Hospitals, High-Volume; D006780:Hospitals, Rural; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016730:Program Development; D019114:Remote Consultation / Q000458:organization & administration; D013503:Surgery Department, Hospital / Q000458:organization & administration*