20 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Sopra Grande, 4. OG
Outpatient endovascular aortic aneurysm repair: A 7 year experience
D. Jaeger, G. Puippe, T. Pfammatter, R. Kopp, A. Palma, M. Hofmann, H. Szèkessy, D. Bettex, B. Krueger, M. Lachat, Z. Rancic, Presenter: D. Jaeger (Zürich)
Endovascular aortic aneurysm repair is slowly replacing open surgery due to minimal invasiveness, wich reduces the intra- and postoperative complications, favourable for polymorbid patients in particular. To present the safety, feasibility, and treatment of patients with outpatient endovascular aneurysm repair (EVAR) during a seven-year period we started the outpatient EVAR program in 2011.
All clinical data of patients were collected prospectively and analyzed in December 2018. The first feasibility period was from April 2011 to October 2012, the second from November 2012 to December 2018. All treated patients were asymptomatic. In the first period EVAR was done in patients with favourable anatomy, at least adequate proximal and distal landing zone of 8mm, not severely calcified access vessels. In patients with juxtarenal aneurysms and aneurysm neck 3-7mm, the adequate proximal landing zone was obtained using parallel grafts (PG). In the second period patients treated as outpatient beside EVAR and PG-EVAR, were TEVAR and EVAR combined with iliacal branch device (IBD). Patients were discharged and checked in fixed algorism in outpatient clinic.
In the first period there were 72 patients with EVAR and 5 Chimney-EVAR. In the second period there were 139 patients with EVAR, 10 Chimney-EVAR and 12 TEVAR. In the fist period four patients (4%) with access vessel complications required additional procedures and had to be hospitalised overnight. In the second period 10 patients (6%) were hospitalized overnight: two (1.2%) for logistic reasons, one (0.6%) for acute delirium, two (1.2%) with new onset of back pain after TEVAR that resolved in 12 hours, two (1.2%) with access vessel complications, two (1.2%) with retroperitoneal bleeding, and one (0.6%) with an inadventerly covered and immediately reopened renal artery. There was no conversion to open surgery. There was no 30-day mortality.
Elective outpatient endovacular aortic aneurysm repair can be performed safely. During the seven-year period we moved from simple, favourable EVAR to more complex endovascular procedures. The standard operating procedure must be clear for all involved: patient, familly, general practioner, and hospital staff. Moreover, certain criteria must be fulfilled and specific precautions must be taken.