Comparison of EVAR and open repair AAA in CRH during learning curve period

Abstract

Background: at last decade, philosophy of minimal invasive was major concern in every vascular surgery and the paradigm was shipped from open surgery to endovascular surgery. Patients who treated with endovascular were better in short-term outcomes and had positive effects for develop tertiary care hospital. But in this setting, hospital had to take responsibility about personnel, equipment and the most important was costs. In learning curve period of endovascular treatment, the outcome will unpredictably due to limitation of resources and experience.

Objective: We interested to comparison of outcomes and cost between open repair technique and EVAR for treat patients with infra-renal abdominal aortic aneurysm.

Method: We recruit all infrarenal AAA in Chiangrai Prachanukroh hospital during October 2015 to June 2018 in either elective or emergency setting. We exclude patients with suprarenal type, aortic dissection, patients were surgical repaired without CTA and patients that had unstable vital sign or post CPR at first presentation. Patients were separated into 2 groups and we compared about basic characteristic of patients, related anatomy of disease, outcome and finally total cost expenditures after treatment.

Results:  172 medical record of patients with aortic aneurysm was reviewed. 87 charts were excluded, and 85 charts were separate to 41 patients in open group and 44 charts in EVAR group. There were no different of basic characteristic between two groups but in anatomy related of disease we found that aneurysm size was bigger in open repair group (70.25 +/- 14.9: 59.6 +/- 12.9 mm, p <0.001). The EVAR group had larger neck area of aneurysm (21.4 +/- 13.2: 29 +/- 11.5 mm, p 0.006). In term of disease outcome, we found that its similar with prior study that EVAR was better in short term outcome and fewer complication. But cost of EVAR were significant more cost expenditure than open repair (579,039 +/- 114,247.1:147,865.4 +/- 76,992.9 bath, p<0.001).

Conclusions: In learning curve period, EVAR can achieve the good outcome independent to patients or personnel experience if we can select proper patients. But cost expenditure should still be concern in tertiary care hospital although hospital tend to have profit more than open repair after receive compensation from government.