Endovascular Aneurysm Repair (EVAR): A Non-Academic Community Hospital’s Experience

OBJECTIVES: EVAR has become the first line treatment of AAA. Outcomes outside of the tertiary care setting remain unknown. The purpose of this study is to report on the mid-term outcomes of EVAR in a community based hospital setting.
METHODS: A retrospective review of 75 elective consecutive EVARs performed at a single community hospital was performed between May 2002 and December 2006. Follow up included a CT scan at 3, 6, and 12 months.
RESULTS:
A bifurcated modular graft was used in all cases. Most patients were in a high-risk modified Goldman class II/III. The mean preoperative aneurysm diameter was 55±9mm, and the mean aortic neck length was 15.5±14mm. There were no open conversions, and no major complications. The mean hospital stay was 1.5± 1.6 days. The mean follow-up was 18 months. There were no postoperative ruptures or aneurysm related death. There were no graft migrations or type I endoleaks. There was a 7% decrease in mean aneurysm diameter at follow up. Reintervention with coil embolization was required for 2 patients for persistent type II endoleak. At 24 months, the freedom from aneurysm related death was 100%, the freedom from secondary interventions was 91%, and the freedom from endoleak was 69%. Overall Survival was 97% at 2 years (Fig 1). CONCLUSIONS: EVAR at a community hospital is safe and durable, even in a high risk population, with outcomes comparable to tertiary care centers. EVAR should be the first line treatment for elective AAA in the community setting.