title: Thirty-Day Outcomes after Elective Percutaneous or Open Endovascular Repair of Abdominal Aortic Aneurysms.
abstract: BACKGROUND
  Percutaneous endovascular aneurysm repair (PEVAR) has become accepted as a suitable alternative to open EVAR (OEVAR) in the treatment of abdominal aortic aneurysms (AAAs). Direct comparisons between the 2 techniques have been infrequently reported and have predominantly focused on immediate procedural outcomes. The objective of this study was to compare contemporary 30-day postoperative outcomes between successfully completed elective PEVAR and OEVAR.
  
  
  METHODS
  The 2012 National Surgical Quality Improvement Program database was queried for all elective primary AAA repairs. Procedures on ruptured AAAs and those involving adjunctive thoracic, abdominal, or extremity procedures were excluded. Cases completed with at least one surgical exposure of the femoral artery for access (OPEN) were compared with those completed without such exposure (PERC). Preoperative, intraoperative, and 30-day postoperative variables were compared using appropriate univariate statistical tests. A P value of ≤0.05 was considered significant for all comparisons.
  
  
  RESULTS
  A total of 1,589 (51%) OPEN and 1,533 (49%) PERC cases met inclusion and exclusion criteria. Preoperative characteristics did not differ between groups. OPEN cases took significantly longer (150 ± 69 min) than PERC cases (134 ± 65 min, P < 0.001). No significant differences were found between the groups in any postoperative occurrence, but the rate of venous thromboembolism twice as high in OPEN (16, 1.0%) than PERC cases (7, 0.5%, P = 0.07). In addition, wound complications (36, 2.3% OPEN vs. 23, 1.3% PERC, P = 0.11) were more common in OPEN cases but were diagnosed a week sooner on average in PERC cases (19 days OPEN and 12 days PERC). Median postoperative length of stay was 2 days among OPEN cases versus 1 day in PERC cases (P = 0.11). Female gender and obesity predicted wound complications in the OPEN group but not in the PERC group.
  
  
  CONCLUSIONS
  Successfully completed PEVAR and OEVAR have similar rates of overall complications. Female gender and obesity predict wound complications in OEVAR but not in PEVAR, which appears to be a safe alternative to OEVAR. PEVAR has the advantage of shorter operative time and the potential for a shorter postoperative stay, and may offer the advantage of fewer wound complications in females and obese patients.
authors.affiliation: Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: davekauvar@gmail.com.
authors.forename: David S
authors.initials: DS
authors.lastname: Kauvar
authors.affiliation: Department of Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Martin
authors.affiliation: Department of Radiology, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Givens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States