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SS31 Effects of Different Stent Designs on Limb Flexion-Induced Axial Compression, Bending, and Torsion in Human Femoropopliteal Arteries
140S
Journal of Vascular Surgery
Abstracts
June Supplement 2017 Table. Definitions of Medicare Severity-Diagnosis-Related Group (MSDRG) codes and classifications in this study MSClassification DRG Standard
Complex
Definition
Patients (total N ¼ 104)
238 Major cardiovascular surgical procedure without complication
88
254 Other vascular procedure without complication
6
237 Major cardiovascular surgical procedure with major complication
9
252 Other vascular surgical procedure with major complication
0
253 Other vascular surgical procedure with complication
1
Author Disclosures: S. S. Ayub: Nothing to disclose; D. K. Bielick: Nothing to disclose; J. Fatima: Nothing to disclose; K. A. Giles: Nothing to disclose; T. S. Huber: Nothing to disclose; S. T. Scali: Nothing to disclose.
SS29. Endovascular Aortic Repair Follow-Up Protocol Based on Contrast-Enhanced Ultrasound Is Safe and Effective in a Midterm Period Emiliano Chisci, Azzurra Guidotti, Clara Pigozzi, Angelica Pecchioli, Aldo Alberti, Renzo Lombardi, Leonardo Ercolini, Stefano Michelagnoli. San Giovanni di Dio Hospital, Florence, Italy Objectives: The aim of this study was to define the safety and effectiveness of a contrast-enhanced ultrasound (CEUS)-based follow-up as endovascular aortic repair (EVAR) surveillance model at a midterm period of 4 years. Methods: At our tertiary referral center, EVAR surveillance was based on plain abdominal radiographs and duplex ultrasound imaging, with computed tomography angiography (CTA) reserved for any abnormalities or nondiagnostic imaging during the period 1999 to 2011 (group A). From 2012, CEUS imaging was started to be performed in case of presence of (1) any endoleak, (2) significant aneurysm expansion (sac growth >5 mm #6 months), and patients with (3) renal insufficiency (chronic kidney disease stage $3) or (4) iodine contrast allergy (group B). Results: Included were 880 patients (mean age, 75.6 6 8.4 years; 824 men) who underwent EVAR between 1999 and 2015 and with a minimum of 1 year follow-up; of these, 619 patients were in group A (70%) and the remaining 261 in group B (30%). Median follow-up was 48 months (interquartile range, 24-84). During the study period 318 CEUS imaging studies were performed with zero related complications. Indications for CEUS were a ¼ 160 (50%), b ¼ 34 (11%), c ¼ 91 (29%), and d ¼ 33 (10%). CEUS was compared to CTA in the first 100 patients, and CEUS had 100% sensitivity and 100% specificity in classify endoleaks. Moreover, CTA misclassified two type II endoleaks (one as type I and one as type III). In all cases, CEUS was able to detect the presence and type of endoleak. Survival was 94.5% at 2 years, 80.6% at 4 years, 74.5% at 6 years, and 62.8% at 8 years. Six aneurysm-related deaths occurred, four (0.6%) in group A and two (0.7%) in group B (P ¼ .275). Freedom from endoleak was 86.4% at 2 years, 81% at 4 years, 79.3% at 6 years, and 73.2% at 8 years. Freedom from reintervention was 95.6% at 2 years, 94.1% at 4 years, 90.4% at 6 years, and 87.1% at 8 years. No differences in endoleak, reinterventions, and sac shrinkage rate were seen between the two groups at 4 years. A 4-year analysis of CTA usage allowed for a 90% reduction with the CEUS introduction. Conclusions: The introduction of a CEUS-based protocol for EVAR follow-up was safe and effective and was comparable to the previous CTA-based protocol follow-up in a midterm period. Moreover, CEUS allowed for 90% reduction of CTA. Author Disclosures: A. Alberti: Nothing to disclose; E. Chisci: Nothing to disclose; L. Ercolini: Nothing to disclose; A. Guidotti: Nothing to disclose; R. Lombardi: Nothing to disclose; S. Michelagnoli: Nothing to disclose; A. Pecchioli: Nothing to disclose; C. Pigozzi: Nothing to disclose.
SS30. Vascular Surgery Patients With Coronary Drug-Eluting Stents Have a Significantly Increased Risk of Perioperative MI Despite the Use of Appropriate Antiplatelet Medications Caron Rockman, Thomas Maldonado, Glenn Jacobowitz, Yu Guo, Neal Cayne, Mikel Sadek, Jeffrey Berger. New York University, New York, NY Objectives: There are no universally accepted guidelines regarding patients who require noncardiac surgery following the placement of drugeluting stents (DES) in the coronary arteries. Delaying elective surgery and maintaining antiplatelet medications have been suggested to reduce the risk of perioperative cardiac complications. The objectives of this study were to evaluate factors predisposing towards perioperative myocardial infarction (MI) in a prospectively studied patient population undergoing open vascular surgery. Methods: Data were prospectively collected and subsequently analyzed as part of an American Heart Association funded singleinstitution clinical trial designed to analyze factors predisposing towards thrombotic and hemorrhagic complications in patients undergoing open vascular surgery. Perioperative MI was diagnosed by electrocardiogram results, relevant symptoms, and troponin levels using American College of Cardiology/American Heart Association guidelines. Results: A cohort of 125 patients (30.2% women) who underwent carotid endarterectomy or lower extremity bypass procedures was analyzed; of these, 42.6% had a history of coronary disease, 14.7% had a history of MI, 31% had diabetes, 86.8% had hyperlipidemia, and 91.5% had hypertension. Of the entire cohort, 17 (13.6%) had a prior coronary DES. The incidence of perioperative MI was significantly increased among DES patients compared to those without (23.5% vs 3.7%; P ¼ .01). In contrast, patients with bare metal stents did not have a significantly increased risk of perioperative MI. We examined preoperative medications and the timing of surgery, and none of these factors had a significant effect on the rate of perioperative MI. Of DES patients who sustained a perioperative MI: all had taken aspirin within 24 hours of surgery; 75% had taken clopidogrel within 24 hours of surgery; 75% had taken a statin within 24 hours of surgery; and all were treated with bblockers and an angiotensin-converting enzyme inhibitor. Half (50%) of the perioperative MIs in DES patients occurred after carotid endarterectomy, and 50% occurred following or lower extremity bypass. Half (50%) of the perioperative MIs in DES patients occurred in patients with a remote history of DES (>3 years prior), and 50% occurred in cases in which the DES was placed within 1 year prior to surgery. Conclusions: Patients with coronary DES remain at significantly increased risk for perioperative MI following open vascular surgery, even several years following DES placement. While appropriate medical management of these patients is imperative, it appears that it does not eliminate the risk of perioperative cardiac complications. An appropriate riskto-benefit analysis must be performed in patients with prior DES who require open vascular surgery procedures to determine the appropriate individual course of treatment. Author Disclosures: J. Berger: Nothing to disclose; N. Cayne: Nothing to disclose; Y. Guo: Nothing to disclose; G. Jacobowitz: Nothing to disclose; T. Maldonado: Nothing to disclose; C. Rockman: Nothing to disclose; M. Sadek: Nothing to disclose.
SS31. Effects of Different Stent Designs on Limb Flexion-Induced Axial Compression, Bending, and Torsion in Human Femoropopliteal Arteries William Poulson, MD, Alexey Kamenskiy, MD, Paul Deegan, MD, Carol Lomneth, MD, Jason MacTaggart, MD, Andreas Seas, MD. University of Maryland, Baltimore, Md Objectives: Endovascular reconstructions of the femoropopliteal artery (FPA) demonstrate high rates of failure. Poor durability of repair is often attributed to severe mechanical deformations that occur with limb flexion and inability of stent designs to accommodate these deformations. Stent-artery interactions associated with limb flexion-induced
Journal of Vascular Surgery
Abstracts
141S
Volume 65, Number 6S FPA deformations may contribute to arterial wall injury and intimal hyperplasia. We measured limb flexion-induced deformations of human cadaveric FPAs before and after stenting with seven different commercially available peripheral artery stents. Methods: Retrievable nitinol markers were deployed into 28 in situ FPAs of 14 human cadavers. Limbs were perfused with 37 C fluid, and thin-section computed tomography images were acquired with limbs in the standing (180 ), walking (110 ), sitting (90 ) and gardening (60 ) postures. Image segmentation and analysis allowed comparison of relative spatial locations of each intra-arterial marker for determination of baseline FPA axial compression, bending, and torsion. Markers were then retrieved from the arteries, and the FPAs were stented with preand post-balloon dilatation. Zilver, Absolute Pro, Innova, Smart Control, SmartFlex, Supera stents, and Viabahn stent grafts were deployed across the adductor hiatus. Four unique limbs received each stent type with only one stent type per artery. After stenting, markers were redeployed in stented FPAs and imaged in the same postures. Comparison of the baseline and stented FPA deformations allowed determination of the influence of specific stent type (Fig). Results: Smart Control, Smart Flex, Zilver, Supera, and Absolute Pro restricted axial compression of the FPA within the stented segment by 56%, 45%, 42%, 26%, and 22%, respectively (P < .05). Smart Flex, Smart Control, and Zilver exacerbated FPA compression distal to the stent by 61% (P < .01), while no differences were observed proximally. Within the stented segment, maximum torsion was restricted by Supera 4 to 12 / cm (P < .05), and exacerbated by Smart Flex 10 to 15 /cm (P < .05). Torsion of the FPA proximal and distal to the stented region was not affected by stenting. Stents reduced bending of the FPA by an average of 42% (P < .01) within the stented segment, but no differences were observed proximally or distally. Conclusions: Different stent designs significantly affect limb flexioninduced deformations of the FPA not only within the stented segment but also distal to it. Stents that better match natural limb flexion-induced FPA deformations may mitigate arterial injury and potentially improve clinical outcomes of endovascular peripheral artery disease treatments. These data can be used to help more rationally select stent designs specific to arterial segments and patient conditions.
Fig. Author Disclosures: P. Deegan: Nothing to disclose; A. Kamenskiy: Nothing to disclose; C. Lomneth: Nothing to disclose; J. MacTaggart: Nothing to disclose; W. Poulson: Nothing to disclose; A. Seas: Nothing to disclose.
C10: POSTER COMPETITION PC002. Cost Analysis of Fenestrated vs Standard Endovascular Repair of Nonruptured Abdominal Aortic Aneurysm in the United States Satinderjit S. Locham, Besma Nejim, Hanaa N. Dakour Aridi, Muhammad Faateh, Muhammad Rizwan, Mahmoud B. Malas. Johns Hopkins University School of Medicine, Baltimore, Md Objectives: Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive approach to include patients with pararenal aneurysms. However, it takes about 4 to 6 weeks to manufacture these grafts. The actual cost of this relatively newer technology has not been studied before. The aim of this study was to analyze the cost for patients undergoing FEVAR vs standard endovascular aneurysm repair (EVAR) for nonruptured abdominal aortic aneurysms (AAA). Methods: Using the Premier Database (2011-2015), we identified all patients who underwent elective EVAR and FEVAR. Student t-tests, c2, medians test, and univariate and multivariate generalized linear modeling were implemented to examine in-hospital cost adjusting for patients’ demographics and regional characteristics. Results: A total of 22,497 elective endovascular AAA repairs were performed. Of these, 1719 (7.6%) underwent FEVAR and 20,778 (92.4%) standard EVAR. The majority of patients undergoing FEVAR were white (86% vs 84%; P ¼ .001) and more likely to be smokers (61% vs 58%; P < .03). Both groups had similar comorbidities, except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8% vs 6%; P ¼ .002). The rates of any complication (11% vs 10%), renal (6% vs 4%), and neurologic injury (0.5% vs 0.2%) were higher in the FEVAR group (all P < .05). No differences in mortality (0.8% vs 0.6%), cardiac (4.7% vs 4.4%), respiratory (2.4% vs 2.1%), and gastrointestinal (1.5% vs 1.1%) complications were observed between the two groups (all P > .05). The median total cost and variable cost of the treatment was significantly higher among patients undergoing FEVAR; however, no difference was seen in the fixed cost between the groups (Fig). After adjusting for patients’ characteristics and comorbidities, the multivariate analysis showed that the cost of FEVAR was on average $1569 higher than EVAR (95% confidence interval, 981-2158; P < .001). Additionally, the adjusted average cost of any endovascular AAA repair was higher among blacks and sicker patients and higher across all regions as compared to the Midwest (Table). Conclusions: In this large cohort of elective endovascular AAA repair, we showed that the total cost of FEVAR is significantly higher than the cost of standard EVARs, despite adjusting for patient’s demographics and comorbidities. This is likely driven by the additional cost of fenestrated endografts and by the increase rate of complications related to FEVAR such as higher renal and neurological injuries. Marked racial and regional disparity in the cost exists among patients undergoing endovascular AAA repair in the United States.
VS09. Robotic-Assisted Left Renal Vein Transposition: A Novel Surgical Technique for the Treatment of Renal Nutcracker Syndrome Anthony Chau, MD, Haidar Abdul-Muhsin, MD, Kate Peng, MD, Christopher Martin, MD, Erik Castle, MD, Samuel Money, MD. Mayo Clinic, Phoenix, Ariz Background: This is a video case presentation of a novel minimally invasive technique to treat renal nutcracker syndrome. Robotic assisted transposition of the left renal vein is feasible, safe and effective. http://www.conferenceabstracts.com/uploads/cfp2/attachments/ZRFDQ HCR/ZRFDQHCR–284559-1-ANY (1).mpg Author Disclosures: H. Abdul-Muhsin: Nothing to disclose; E. P. Castle: Nothing to disclose; A. H. Chau: Nothing to disclose; C. Martin: Nothing to disclose; S. R. Money: Nothing to disclose; K. Peng: Nothing to disclose.
Fig. The median cost of treatment of fenestrated (FEVAR) and standard endovascular revascularization (EVAR) for elective nonruptured abdominal aortic aneurysm repair.
Journal of Vascular Surgery
Abstracts
June Supplement 2017 Table. Definitions of Medicare Severity-Diagnosis-Related Group (MSDRG) codes and classifications in this study MSClassification DRG Standard
Complex
Definition
Patients (total N ¼ 104)
238 Major cardiovascular surgical procedure without complication
88
254 Other vascular procedure without complication
6
237 Major cardiovascular surgical procedure with major complication
9
252 Other vascular surgical procedure with major complication
0
253 Other vascular surgical procedure with complication
1
Author Disclosures: S. S. Ayub: Nothing to disclose; D. K. Bielick: Nothing to disclose; J. Fatima: Nothing to disclose; K. A. Giles: Nothing to disclose; T. S. Huber: Nothing to disclose; S. T. Scali: Nothing to disclose.
SS29. Endovascular Aortic Repair Follow-Up Protocol Based on Contrast-Enhanced Ultrasound Is Safe and Effective in a Midterm Period Emiliano Chisci, Azzurra Guidotti, Clara Pigozzi, Angelica Pecchioli, Aldo Alberti, Renzo Lombardi, Leonardo Ercolini, Stefano Michelagnoli. San Giovanni di Dio Hospital, Florence, Italy Objectives: The aim of this study was to define the safety and effectiveness of a contrast-enhanced ultrasound (CEUS)-based follow-up as endovascular aortic repair (EVAR) surveillance model at a midterm period of 4 years. Methods: At our tertiary referral center, EVAR surveillance was based on plain abdominal radiographs and duplex ultrasound imaging, with computed tomography angiography (CTA) reserved for any abnormalities or nondiagnostic imaging during the period 1999 to 2011 (group A). From 2012, CEUS imaging was started to be performed in case of presence of (1) any endoleak, (2) significant aneurysm expansion (sac growth >5 mm #6 months), and patients with (3) renal insufficiency (chronic kidney disease stage $3) or (4) iodine contrast allergy (group B). Results: Included were 880 patients (mean age, 75.6 6 8.4 years; 824 men) who underwent EVAR between 1999 and 2015 and with a minimum of 1 year follow-up; of these, 619 patients were in group A (70%) and the remaining 261 in group B (30%). Median follow-up was 48 months (interquartile range, 24-84). During the study period 318 CEUS imaging studies were performed with zero related complications. Indications for CEUS were a ¼ 160 (50%), b ¼ 34 (11%), c ¼ 91 (29%), and d ¼ 33 (10%). CEUS was compared to CTA in the first 100 patients, and CEUS had 100% sensitivity and 100% specificity in classify endoleaks. Moreover, CTA misclassified two type II endoleaks (one as type I and one as type III). In all cases, CEUS was able to detect the presence and type of endoleak. Survival was 94.5% at 2 years, 80.6% at 4 years, 74.5% at 6 years, and 62.8% at 8 years. Six aneurysm-related deaths occurred, four (0.6%) in group A and two (0.7%) in group B (P ¼ .275). Freedom from endoleak was 86.4% at 2 years, 81% at 4 years, 79.3% at 6 years, and 73.2% at 8 years. Freedom from reintervention was 95.6% at 2 years, 94.1% at 4 years, 90.4% at 6 years, and 87.1% at 8 years. No differences in endoleak, reinterventions, and sac shrinkage rate were seen between the two groups at 4 years. A 4-year analysis of CTA usage allowed for a 90% reduction with the CEUS introduction. Conclusions: The introduction of a CEUS-based protocol for EVAR follow-up was safe and effective and was comparable to the previous CTA-based protocol follow-up in a midterm period. Moreover, CEUS allowed for 90% reduction of CTA. Author Disclosures: A. Alberti: Nothing to disclose; E. Chisci: Nothing to disclose; L. Ercolini: Nothing to disclose; A. Guidotti: Nothing to disclose; R. Lombardi: Nothing to disclose; S. Michelagnoli: Nothing to disclose; A. Pecchioli: Nothing to disclose; C. Pigozzi: Nothing to disclose.
SS30. Vascular Surgery Patients With Coronary Drug-Eluting Stents Have a Significantly Increased Risk of Perioperative MI Despite the Use of Appropriate Antiplatelet Medications Caron Rockman, Thomas Maldonado, Glenn Jacobowitz, Yu Guo, Neal Cayne, Mikel Sadek, Jeffrey Berger. New York University, New York, NY Objectives: There are no universally accepted guidelines regarding patients who require noncardiac surgery following the placement of drugeluting stents (DES) in the coronary arteries. Delaying elective surgery and maintaining antiplatelet medications have been suggested to reduce the risk of perioperative cardiac complications. The objectives of this study were to evaluate factors predisposing towards perioperative myocardial infarction (MI) in a prospectively studied patient population undergoing open vascular surgery. Methods: Data were prospectively collected and subsequently analyzed as part of an American Heart Association funded singleinstitution clinical trial designed to analyze factors predisposing towards thrombotic and hemorrhagic complications in patients undergoing open vascular surgery. Perioperative MI was diagnosed by electrocardiogram results, relevant symptoms, and troponin levels using American College of Cardiology/American Heart Association guidelines. Results: A cohort of 125 patients (30.2% women) who underwent carotid endarterectomy or lower extremity bypass procedures was analyzed; of these, 42.6% had a history of coronary disease, 14.7% had a history of MI, 31% had diabetes, 86.8% had hyperlipidemia, and 91.5% had hypertension. Of the entire cohort, 17 (13.6%) had a prior coronary DES. The incidence of perioperative MI was significantly increased among DES patients compared to those without (23.5% vs 3.7%; P ¼ .01). In contrast, patients with bare metal stents did not have a significantly increased risk of perioperative MI. We examined preoperative medications and the timing of surgery, and none of these factors had a significant effect on the rate of perioperative MI. Of DES patients who sustained a perioperative MI: all had taken aspirin within 24 hours of surgery; 75% had taken clopidogrel within 24 hours of surgery; 75% had taken a statin within 24 hours of surgery; and all were treated with bblockers and an angiotensin-converting enzyme inhibitor. Half (50%) of the perioperative MIs in DES patients occurred after carotid endarterectomy, and 50% occurred following or lower extremity bypass. Half (50%) of the perioperative MIs in DES patients occurred in patients with a remote history of DES (>3 years prior), and 50% occurred in cases in which the DES was placed within 1 year prior to surgery. Conclusions: Patients with coronary DES remain at significantly increased risk for perioperative MI following open vascular surgery, even several years following DES placement. While appropriate medical management of these patients is imperative, it appears that it does not eliminate the risk of perioperative cardiac complications. An appropriate riskto-benefit analysis must be performed in patients with prior DES who require open vascular surgery procedures to determine the appropriate individual course of treatment. Author Disclosures: J. Berger: Nothing to disclose; N. Cayne: Nothing to disclose; Y. Guo: Nothing to disclose; G. Jacobowitz: Nothing to disclose; T. Maldonado: Nothing to disclose; C. Rockman: Nothing to disclose; M. Sadek: Nothing to disclose.
SS31. Effects of Different Stent Designs on Limb Flexion-Induced Axial Compression, Bending, and Torsion in Human Femoropopliteal Arteries William Poulson, MD, Alexey Kamenskiy, MD, Paul Deegan, MD, Carol Lomneth, MD, Jason MacTaggart, MD, Andreas Seas, MD. University of Maryland, Baltimore, Md Objectives: Endovascular reconstructions of the femoropopliteal artery (FPA) demonstrate high rates of failure. Poor durability of repair is often attributed to severe mechanical deformations that occur with limb flexion and inability of stent designs to accommodate these deformations. Stent-artery interactions associated with limb flexion-induced
Journal of Vascular Surgery
Abstracts
141S
Volume 65, Number 6S FPA deformations may contribute to arterial wall injury and intimal hyperplasia. We measured limb flexion-induced deformations of human cadaveric FPAs before and after stenting with seven different commercially available peripheral artery stents. Methods: Retrievable nitinol markers were deployed into 28 in situ FPAs of 14 human cadavers. Limbs were perfused with 37 C fluid, and thin-section computed tomography images were acquired with limbs in the standing (180 ), walking (110 ), sitting (90 ) and gardening (60 ) postures. Image segmentation and analysis allowed comparison of relative spatial locations of each intra-arterial marker for determination of baseline FPA axial compression, bending, and torsion. Markers were then retrieved from the arteries, and the FPAs were stented with preand post-balloon dilatation. Zilver, Absolute Pro, Innova, Smart Control, SmartFlex, Supera stents, and Viabahn stent grafts were deployed across the adductor hiatus. Four unique limbs received each stent type with only one stent type per artery. After stenting, markers were redeployed in stented FPAs and imaged in the same postures. Comparison of the baseline and stented FPA deformations allowed determination of the influence of specific stent type (Fig). Results: Smart Control, Smart Flex, Zilver, Supera, and Absolute Pro restricted axial compression of the FPA within the stented segment by 56%, 45%, 42%, 26%, and 22%, respectively (P < .05). Smart Flex, Smart Control, and Zilver exacerbated FPA compression distal to the stent by 61% (P < .01), while no differences were observed proximally. Within the stented segment, maximum torsion was restricted by Supera 4 to 12 / cm (P < .05), and exacerbated by Smart Flex 10 to 15 /cm (P < .05). Torsion of the FPA proximal and distal to the stented region was not affected by stenting. Stents reduced bending of the FPA by an average of 42% (P < .01) within the stented segment, but no differences were observed proximally or distally. Conclusions: Different stent designs significantly affect limb flexioninduced deformations of the FPA not only within the stented segment but also distal to it. Stents that better match natural limb flexion-induced FPA deformations may mitigate arterial injury and potentially improve clinical outcomes of endovascular peripheral artery disease treatments. These data can be used to help more rationally select stent designs specific to arterial segments and patient conditions.
Fig. Author Disclosures: P. Deegan: Nothing to disclose; A. Kamenskiy: Nothing to disclose; C. Lomneth: Nothing to disclose; J. MacTaggart: Nothing to disclose; W. Poulson: Nothing to disclose; A. Seas: Nothing to disclose.
C10: POSTER COMPETITION PC002. Cost Analysis of Fenestrated vs Standard Endovascular Repair of Nonruptured Abdominal Aortic Aneurysm in the United States Satinderjit S. Locham, Besma Nejim, Hanaa N. Dakour Aridi, Muhammad Faateh, Muhammad Rizwan, Mahmoud B. Malas. Johns Hopkins University School of Medicine, Baltimore, Md Objectives: Fenestrated endovascular aneurysm repair (FEVAR) has expanded the indications of this minimally invasive approach to include patients with pararenal aneurysms. However, it takes about 4 to 6 weeks to manufacture these grafts. The actual cost of this relatively newer technology has not been studied before. The aim of this study was to analyze the cost for patients undergoing FEVAR vs standard endovascular aneurysm repair (EVAR) for nonruptured abdominal aortic aneurysms (AAA). Methods: Using the Premier Database (2011-2015), we identified all patients who underwent elective EVAR and FEVAR. Student t-tests, c2, medians test, and univariate and multivariate generalized linear modeling were implemented to examine in-hospital cost adjusting for patients’ demographics and regional characteristics. Results: A total of 22,497 elective endovascular AAA repairs were performed. Of these, 1719 (7.6%) underwent FEVAR and 20,778 (92.4%) standard EVAR. The majority of patients undergoing FEVAR were white (86% vs 84%; P ¼ .001) and more likely to be smokers (61% vs 58%; P < .03). Both groups had similar comorbidities, except for cerebrovascular disease, which was higher among patients undergoing FEVAR (8% vs 6%; P ¼ .002). The rates of any complication (11% vs 10%), renal (6% vs 4%), and neurologic injury (0.5% vs 0.2%) were higher in the FEVAR group (all P < .05). No differences in mortality (0.8% vs 0.6%), cardiac (4.7% vs 4.4%), respiratory (2.4% vs 2.1%), and gastrointestinal (1.5% vs 1.1%) complications were observed between the two groups (all P > .05). The median total cost and variable cost of the treatment was significantly higher among patients undergoing FEVAR; however, no difference was seen in the fixed cost between the groups (Fig). After adjusting for patients’ characteristics and comorbidities, the multivariate analysis showed that the cost of FEVAR was on average $1569 higher than EVAR (95% confidence interval, 981-2158; P < .001). Additionally, the adjusted average cost of any endovascular AAA repair was higher among blacks and sicker patients and higher across all regions as compared to the Midwest (Table). Conclusions: In this large cohort of elective endovascular AAA repair, we showed that the total cost of FEVAR is significantly higher than the cost of standard EVARs, despite adjusting for patient’s demographics and comorbidities. This is likely driven by the additional cost of fenestrated endografts and by the increase rate of complications related to FEVAR such as higher renal and neurological injuries. Marked racial and regional disparity in the cost exists among patients undergoing endovascular AAA repair in the United States.
VS09. Robotic-Assisted Left Renal Vein Transposition: A Novel Surgical Technique for the Treatment of Renal Nutcracker Syndrome Anthony Chau, MD, Haidar Abdul-Muhsin, MD, Kate Peng, MD, Christopher Martin, MD, Erik Castle, MD, Samuel Money, MD. Mayo Clinic, Phoenix, Ariz Background: This is a video case presentation of a novel minimally invasive technique to treat renal nutcracker syndrome. Robotic assisted transposition of the left renal vein is feasible, safe and effective. http://www.conferenceabstracts.com/uploads/cfp2/attachments/ZRFDQ HCR/ZRFDQHCR–284559-1-ANY (1).mpg Author Disclosures: H. Abdul-Muhsin: Nothing to disclose; E. P. Castle: Nothing to disclose; A. H. Chau: Nothing to disclose; C. Martin: Nothing to disclose; S. R. Money: Nothing to disclose; K. Peng: Nothing to disclose.
Fig. The median cost of treatment of fenestrated (FEVAR) and standard endovascular revascularization (EVAR) for elective nonruptured abdominal aortic aneurysm repair.