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Fenestrated Endovascular Aortic Aneurysm Repair
JOURNAL OF VASCULAR SURGERY Volume 63, Number 6S
used in 196 (58.9%) and complex 3x/4x FEVAR in 137 (41.1%) patients. Overall technical success was 324 of 333 (97.3%), with no statistical significant difference between the two groups (2x FEVAR: 192 of 196 [98%] vs 3x/4x FEVAR: 132 of 137 [96.4%]; P ¼ .5, NS). Mean operative time was 136 6 49 minutes for 2x FEVAR and 174 6 55 minutes for complex 3x/4x FEVAR (P ˂.05). Mean fluoroscopy time was 45 6 17 minutes for 2x FEVAR and 59 6 20 minutes for complex 3x/4x FEVAR (P ˂.05). Overall 30-day mortality was 2 of 333 (0.6%), with no statistical significant difference between the two groups (2x FEVAR: 1 of 196 [0.5%] vs 3x/4x FEVAR: 1 of 137 [0.7%]; P ¼1.0, NS). Major perioperative complications did not differ between the two groups (2x FEVAR: 18 of 196 [9.2%] vs 3x/4x FEVAR: 20 of 137 [14.6%]; P ¼ .16, NS). Mean follow-up was 20 6 16.1 months. Estimated survival at 1 and 3 years was 94.7% 6 2.1% and 80.0% 6 4.7% for 2x FEVAR vs 91.0% 6 3.9% and 84.3% 6 5.1%, respectively, for 3x/4x FEVAR (P ¼ .79, NS). Estimated freedom from reintervention at 1 and 3 years was 96.1% 6 1.7% and 90.0% 6 3.3% for 2x FEVAR vs 97.6% 6 1.7% and 92.1% 6 4.1%, respectively, for 3x/ 4x FEVAR (P ¼ .68, NS). Estimated target vessel patency at 1 and 3 years was 99.5% 6 0.4%, and 99.0% 6 0.3% for 2x FEVAR vs 98.7% 6 0.7% and 98.0% 6 1.0%, respectively, for 3x/4x FEVAR (P ¼ .23, NS). Conclusions: In our experience, complex 3x/4x FEVAR was not associated with an increase in perioperative mortality and morbidity compared to standard 2x FEVAR. Complex 3x/4x FEVAR required longer procedure and fluoroscopy duration. Initial technical success and target vessel patency during follow-up were not affected by increasing device complexity. Author Disclosures: A. Katsargyris: Nothing to disclose; E. Verhoeven: Cook Medical: royalties, intellectual property/patents, consulting fees (eg, advisory boards), speaker’s bureau.
Abstracts 137S
used 100% samples of Medicare Part B claims to ascertain counts of these repair types and compared them annually over the study period. Results: Between 2003 and 2013, the total number of AAA repairs declined by 13% from 27,352 to 23,835 (P ¼ .01), after a peak number of 29,924 was performed in 2005. The number of open AAA repairs steadily declined by a total of 78%, from 15,385 in 2003 to 3315 in 2013 (P < .01). While the number of EVARs increased from 11,967 in 2003 to 20,845 in 2008 (P ¼ .1), it has since declined a total of 13% to only 18,098 repairs in 2013 (P ¼ .09). Prior to 2011, there were no BEVAR cases among Medicare beneficiaries. However, the number of BEVAR cases continuously rose over 500% from 401 procedures in 2011 to 2422 procedures in 2013 (P < .01). Over this same time period, the number of open repairs declined by 2499, and the number of EVARs declined by 2,415. Conclusions: The total number of AAA repairs in the Unites States is declining annually since 2005. The continuous increase in BEVAR cases performed among Medicare patients over the last 3 years has not reversed the steady decline in overall numbers of AAA repairs, due to a concomitant decline in both open aneurysm repair and EVAR. While it could be that the increase in BEVAR was responsible for the decline in open repair, this trend is present over a much longer time period. Over the time period with a rapid rise in BEVAR cases, there is an almost equal decline in EVAR case numbers as well. These trends suggest a potential decline in the incidence of AAA in the U.S. Medicare population, with shifts in the type of repair based on available technology and perhaps patient preference. Future efforts are needed to determine the characteristics of patients treated with BEVAR as well as the long-term effectiveness of these new treatments.
SS18 SS18. The Decline in EVARdNational Trends in Open Surgical, Endovascular and Branched/ Fenestrated Endovascular Aortic Aneurysm Repair Bjoern D. Suckow, MD, MS, Mark F. Fillinger, MD, David H. Stone, MD, Philip P. Goodney, MD, MS. Dartmouth-Hitchcock Medical Center, Lebanon, NH Objectives: With the advent of branched-fenestrated aortic endografts, the number of abdominal aortic aneurysm (AAA) repairs could theoretically increase, due to patients who otherwise would not be offered open repair or infrarenal endovascular repair (EVAR). However, it remains unclear how this novel approach is used in contemporary practice and how it may impact rates of open and standard endovascular repair. Methods: We analyzed trends in open AAA repair, EVAR, and branched/fenestrated EVAR (BEVAR) for AAA in Medicare beneficiaries from 2003 to 2013. We
Fig.
Author Disclosures: M. F. Fillinger: Endologix and W. L. Gore: consulting fees (eg, advisory boards); P. P. Goodney: Nothing to disclose; D. H. Stone: Nothing to disclose; B. D. Suckow: Nothing to disclose.
used in 196 (58.9%) and complex 3x/4x FEVAR in 137 (41.1%) patients. Overall technical success was 324 of 333 (97.3%), with no statistical significant difference between the two groups (2x FEVAR: 192 of 196 [98%] vs 3x/4x FEVAR: 132 of 137 [96.4%]; P ¼ .5, NS). Mean operative time was 136 6 49 minutes for 2x FEVAR and 174 6 55 minutes for complex 3x/4x FEVAR (P ˂.05). Mean fluoroscopy time was 45 6 17 minutes for 2x FEVAR and 59 6 20 minutes for complex 3x/4x FEVAR (P ˂.05). Overall 30-day mortality was 2 of 333 (0.6%), with no statistical significant difference between the two groups (2x FEVAR: 1 of 196 [0.5%] vs 3x/4x FEVAR: 1 of 137 [0.7%]; P ¼1.0, NS). Major perioperative complications did not differ between the two groups (2x FEVAR: 18 of 196 [9.2%] vs 3x/4x FEVAR: 20 of 137 [14.6%]; P ¼ .16, NS). Mean follow-up was 20 6 16.1 months. Estimated survival at 1 and 3 years was 94.7% 6 2.1% and 80.0% 6 4.7% for 2x FEVAR vs 91.0% 6 3.9% and 84.3% 6 5.1%, respectively, for 3x/4x FEVAR (P ¼ .79, NS). Estimated freedom from reintervention at 1 and 3 years was 96.1% 6 1.7% and 90.0% 6 3.3% for 2x FEVAR vs 97.6% 6 1.7% and 92.1% 6 4.1%, respectively, for 3x/ 4x FEVAR (P ¼ .68, NS). Estimated target vessel patency at 1 and 3 years was 99.5% 6 0.4%, and 99.0% 6 0.3% for 2x FEVAR vs 98.7% 6 0.7% and 98.0% 6 1.0%, respectively, for 3x/4x FEVAR (P ¼ .23, NS). Conclusions: In our experience, complex 3x/4x FEVAR was not associated with an increase in perioperative mortality and morbidity compared to standard 2x FEVAR. Complex 3x/4x FEVAR required longer procedure and fluoroscopy duration. Initial technical success and target vessel patency during follow-up were not affected by increasing device complexity. Author Disclosures: A. Katsargyris: Nothing to disclose; E. Verhoeven: Cook Medical: royalties, intellectual property/patents, consulting fees (eg, advisory boards), speaker’s bureau.
Abstracts 137S
used 100% samples of Medicare Part B claims to ascertain counts of these repair types and compared them annually over the study period. Results: Between 2003 and 2013, the total number of AAA repairs declined by 13% from 27,352 to 23,835 (P ¼ .01), after a peak number of 29,924 was performed in 2005. The number of open AAA repairs steadily declined by a total of 78%, from 15,385 in 2003 to 3315 in 2013 (P < .01). While the number of EVARs increased from 11,967 in 2003 to 20,845 in 2008 (P ¼ .1), it has since declined a total of 13% to only 18,098 repairs in 2013 (P ¼ .09). Prior to 2011, there were no BEVAR cases among Medicare beneficiaries. However, the number of BEVAR cases continuously rose over 500% from 401 procedures in 2011 to 2422 procedures in 2013 (P < .01). Over this same time period, the number of open repairs declined by 2499, and the number of EVARs declined by 2,415. Conclusions: The total number of AAA repairs in the Unites States is declining annually since 2005. The continuous increase in BEVAR cases performed among Medicare patients over the last 3 years has not reversed the steady decline in overall numbers of AAA repairs, due to a concomitant decline in both open aneurysm repair and EVAR. While it could be that the increase in BEVAR was responsible for the decline in open repair, this trend is present over a much longer time period. Over the time period with a rapid rise in BEVAR cases, there is an almost equal decline in EVAR case numbers as well. These trends suggest a potential decline in the incidence of AAA in the U.S. Medicare population, with shifts in the type of repair based on available technology and perhaps patient preference. Future efforts are needed to determine the characteristics of patients treated with BEVAR as well as the long-term effectiveness of these new treatments.
SS18 SS18. The Decline in EVARdNational Trends in Open Surgical, Endovascular and Branched/ Fenestrated Endovascular Aortic Aneurysm Repair Bjoern D. Suckow, MD, MS, Mark F. Fillinger, MD, David H. Stone, MD, Philip P. Goodney, MD, MS. Dartmouth-Hitchcock Medical Center, Lebanon, NH Objectives: With the advent of branched-fenestrated aortic endografts, the number of abdominal aortic aneurysm (AAA) repairs could theoretically increase, due to patients who otherwise would not be offered open repair or infrarenal endovascular repair (EVAR). However, it remains unclear how this novel approach is used in contemporary practice and how it may impact rates of open and standard endovascular repair. Methods: We analyzed trends in open AAA repair, EVAR, and branched/fenestrated EVAR (BEVAR) for AAA in Medicare beneficiaries from 2003 to 2013. We
Fig.
Author Disclosures: M. F. Fillinger: Endologix and W. L. Gore: consulting fees (eg, advisory boards); P. P. Goodney: Nothing to disclose; D. H. Stone: Nothing to disclose; B. D. Suckow: Nothing to disclose.