Abdominal aortic aneurysm treatment in Emilia Romagna region

Mascoli, Chiara (2020) Abdominal aortic aneurysm treatment in Emilia Romagna region, [Dissertation thesis], Alma Mater Studiorum Università di Bologna. Dottorato di ricerca in Scienze chirurgiche, 32 Ciclo.
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Abstract

Introduction. Elective endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) has been performed with increasing frequency due to lower 30-day morbidity and mortality compared with open surgical repair(OSR). Similar advantages are reported for ruptured AAAs. Aim of the study was to report the frequencies of EVAR/OSR in elective and acute setting and 30-day outcomes, in two Italian Vascular Surgery of Emilia-Romagna-Region(VS-ERR). Methods. All patients undergoing AAA repair in two VS-ERR (2015-2019), were prospectively collected. Pre-operative, procedural and post-operative data were retrospectively analyzed. Percentage of EVAR/OSR were evaluated for overall, elective and acute patients. Technical-success (TS), intra-operative mortality and procedure-related adverse events (PAE) were assessed. Reinterventions, mortality&morbidity were assessed at 30-day. Results of EVAR and OSR were compared. Reasons of EVAR ineligibility were also investigated and compared. Results. Overall 878 patients underwent AAA repair, 736 in elective (EVAR/OSR:80.4%/19.6%) and 142 in acute setting (EVAR/OSR:71.1%/28.9%). Overall TS was 95.8%, PAE were reported in 9.1% of patients. Overall intraoperative mortality was 0.5%. Post-operative medical complications were reported in 21.2% patients. The mean hospitalization was 6.711.08 days. Overall 30-day-reinterventions and mortality were 3.9% and 4.2%, respectively. In elective-setting, TS was similar between groups(P=.18). OSR had more PAE(P<.001) vs EVAR. There was no difference of intraoperative mortality(P=.62). EVAR had shorter hospitalization(P<.001), less 30-day reintervention(P<.001) and mortality(P<.001) vs OSR. In acute-setting, no significant differences of TS(P=.56) and PAE(P=.18) between groups were observed. OSR had more perioperative medical complications(P<.001) and higher rate of 30-day mortality(P<.001) vs EVAR. The main reason of EVAR exclusion was anatomical unsuitability(94.4%) in elective-setting while logistic cause(61%) in acute-setting. Conclusion. EVAR has progressively increased for elective more than for acute setting. The misalignment of the VS-ERR from literature evidence in acute setting is principally due to logistic reason. According our data, the management of this subgroup of patients, should be improved.

Abstract
Tipologia del documento
Tesi di dottorato
Autore
Mascoli, Chiara
Supervisore
Dottorato di ricerca
Ciclo
32
Coordinatore
Settore disciplinare
Settore concorsuale
Parole chiave
abdominal aortic aneurysm, endovascular repair, open surgical repair, elective setting, acute setting, EVAR ineligibility
URN:NBN
Data di discussione
2 Aprile 2020
URI

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