EVAR vs. OAR: One Community Hospital’s Experience

Westley Smith

Background

Abdominal Aortic Aneurysm (AAA)

http://www.zenithstentgraft.com/patients/US/aaa/what/index.html

Methods

OAR1.Large mid-line incision

2.Aneurysm dissected

3.Graft stitched into place

4.Aorta and Iliac Sutured

Pictures taken from: http://www.guidant.com/webapp/emarketing/compass/comp.jsp?lev1=proc&lev2=aaa

Methods

EVAR1. Small Infrainguinal

Incision

2. Catheter Insertion

3. Portable C-Arm (radiography)

4. Deployment

http://www.guidant.com/webapp/emarketing/compass/comp.jsp?lev1=proc&lev2=aaa

http://www.llnl.gov/str/pdfs/05_00.3.pdf

http://www.ziehm.com/ZiehmVision.htm

Blood F

low

Candidacy

1. Arteriosclerosis

2. Tortuosity

3. Infrarenal neck length/diameter

4. Iliac diameter

5. Patient preference

Comorbidity and Demographics OAR vs. EVAR Comorbidities

0

10

20

30

40

50

60

70

80

90

CoronaryDisease

CongestiveHeart Failure

Irregular HeartRhythm

Hypertension PeripheralVascularDisease

PulmonaryDisease

Diabetes History ofSmoking

Fre

qu

ency

of

Pat

ien

ts

OAR (n = 28) EVAR (n= 72)

Note. *Between groups Pulmonary Disease measured significantly different X2= 13.688, p= .001

*

Anatomic & Demographic ComparisonSurgery

Demographic   OAR   EVAR

Sample Size 28 72

Females / Males 9 / 19 11 / 61

Age ± standard deviation 73 ± 8.0 71 ± 7.6

Surgery

Anatomical Feature   OAR   EVAR

Aneurysm Diameter (cm) 5.06 ± 1.48 5.0 ± .88

Neck Length (cm) 2.03 ± 1.26 1.25 ± 1.20

Neck Diameter (cm) 2.49 ± .47 2.19 ± .40

The Results

  Surgery      

Perioperative Variable   OAR   EVAR   Significance

Operative Time (min) 98 ± 41 126 ± 57 No Significance

Anesthetic Time (min) 240 ± 75 203 ± 67 No Significance

Estimated Blood Loss (cc) 1482 ± 1275 353 ± 285 p < .001

Oral Intake (days) 3.87 ± 2.07 .875 ± .95 p < .001

Ambulation (days) 4.46 ± 4.83 2.33 ± 2.00 p = .018

Postoperative Results

  Surgery      

Postoperative Variable   OAR   EVAR   Significance

Morbidity 17.90% 3.20% χ2 = 16.5, p < .001

Mortality 3.57% 2.80% χ2 = 10.7, p = .005

Conclusions

Candidates for EVAR have tolerated a less invasive procedure without sacrificing postoperative results. The current study is indicative support for the surgeon’s continuation with EVAR – given amendable anatomical characteristics, and pending the long-term results of larger trial facilities.

ReferencesChuter TA, Reilly LM, Faruqui RM, Kerlan RB, Sawhney R, Canto CJ, et al. Endovascular

aneurysm repair in high risk patients. J Vas Surg; 31:122-33, 2000

Marek, J: Endoluminal graft repair of AAA by vascular surgeons at a nonclinical trial center. Presented at the Peripheral Vascular Surgery Society, 11th annual winter meeting, Snowmass, Colorado, January 11-14, 2002.

Moore WS: Two-year follow-up of patients with the EVT/Guidant (Ancure) bifurcated graft for endovascular AAA repair: Advantages and disadvantages of this device. Presented at the 27th Global Veith Meeting, New York City, New York, November 2000.

Abraham CZ, Chuter TA, Reilly LM, Okuhn SP, Pethan LK, Kerlan RB, Sawhney R, Buck DG, Gordon RL, Messina LM, et al: Abdominal aortic aneurysm repair with the Zenith stent graft: Short to midterm results. J Vas Surg; 36:217-225, 2002.

Zarins CK, White RA, Schwarten D, et al: AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical trial. J Vas Surg; 29:292-308, 1999.

Hill BB, Yehuda WG, Lee WA, Arko FR, Cornelius O, Schubart PJ, Dalman RL, Harris JE, Fogarty TJ, Zarins CK, et al: Open versus endovascular AAA repair in patients who are morphological candidates for endovascular treatment. J Endovasc Ther; 9:255-261, 2002.

Special Thanks to:

The Biology Department

&Dr. Daniel McGraw and his Office Staff

Questions