Perioperative differences between endovascular repair of thoracic and abdominal aortic diseases
Background With the US Food and Drug Administration approval of the TAG thoracic device, more thoracic pathologies are being treated using endovascular techniques. Although endovascular abdominal and thoracic aortic repairs have some apparent similarities, there are substantive anatomic, pathologic,...
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| creator | Feezor, Robert J., MD Huber, Thomas S., MD, PhD Martin, Tomas D., MD Beaver, Thomas M., MD Hess, Philip J., MD Klodell, Charles T., MD Nelson, Peter R., MD Berceli, Scott A., MD, PhD Seeger, James M., MD Lee, W. Anthony, MD |
| description | Background With the US Food and Drug Administration approval of the TAG thoracic device, more thoracic pathologies are being treated using endovascular techniques. Although endovascular abdominal and thoracic aortic repairs have some apparent similarities, there are substantive anatomic, pathologic, and technical differences that could impact perioperative outcomes. The purpose of this study is to identify these differences. Methods During a 5-year period, 121 endovascular thoracic aortic repairs (TEVAR) and 450 abdominal aortic repairs (EVAR) were performed at a single institution. Preoperative, intraoperative, and early postoperative data were prospectively collected and retrospectively reviewed. Aggregate outcome measures were compared between the two cohorts, with statistical significance achieved at P < .05. Results The mean age of patients undergoing EVAR was 72.8 ± 8.3 compared with 68.3 ± 13.9 for TEVAR ( P = .02). More women underwent TEVAR (30.6% vs 11.1%, P < .001). Aneurysms undergoing TEVAR were larger than those for EVAR (62.0 mm vs 58.3 mm, P = .01). Intraoperatively, EVAR required 26.2 minutes of fluoroscopy compared with 22.1 minutes for TEVAR ( P < .001). The amount of contrast used was higher in TEVAR (133.6 mL vs 93.6 mL, P < .001). The mean procedure times were 164 minutes for EVAR and 115 minutes for TEVAR ( P < .001). Iliac conduits were required in 46 patients (10.2%) undergoing EVAR, and in 24 (19.8%) undergoing TEVAR ( P = .007). The 30-day or in-hospital mortality was 2.0% for EVAR and 5.0% for TEVAR ( P = NS). The median length of stay was longer for TEVAR (3 days vs 2 days, P = .034). There were 54 postoperative complications in 36 TEVAR patients (29.8%), including 13 neurologic (10.7%), 8 renal (6.6%), 7 pulmonary (5.8%), 6 ischemic (5.0), and 5 (4.1%) hemorrhagic events. Among the EVAR group, 136 (30.2%) patients had postoperative complications, which included 45 ischemic (10.0%), 34 wound (7.6%), 22 renal (4.9%), 12 cardiac (2.7%), 8 pulmonary (1.8%), 5 gastrointestinal (1.1%), and 4 neurologic (0.9%) events. Conclusions A relatively higher proportion of women underwent TEVAR than EVAR, and this was reflected in the greater need for iliac conduits to accommodate the larger delivery catheters of the thoracic devices. Intraoperative imaging techniques were also different, and TEVAR required higher contrast volumes despite shorter overall procedure times. The incidence of strokes and spinal cord ischemia was also higher during |
| doi_str_mv | 10.1016/j.jvs.2006.09.012 |
| format | Article |
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Anthony, MD</creator><creatorcontrib>Feezor, Robert J., MD ; Huber, Thomas S., MD, PhD ; Martin, Tomas D., MD ; Beaver, Thomas M., MD ; Hess, Philip J., MD ; Klodell, Charles T., MD ; Nelson, Peter R., MD ; Berceli, Scott A., MD, PhD ; Seeger, James M., MD ; Lee, W. Anthony, MD</creatorcontrib><description>Background With the US Food and Drug Administration approval of the TAG thoracic device, more thoracic pathologies are being treated using endovascular techniques. Although endovascular abdominal and thoracic aortic repairs have some apparent similarities, there are substantive anatomic, pathologic, and technical differences that could impact perioperative outcomes. The purpose of this study is to identify these differences. Methods During a 5-year period, 121 endovascular thoracic aortic repairs (TEVAR) and 450 abdominal aortic repairs (EVAR) were performed at a single institution. Preoperative, intraoperative, and early postoperative data were prospectively collected and retrospectively reviewed. Aggregate outcome measures were compared between the two cohorts, with statistical significance achieved at P < .05. Results The mean age of patients undergoing EVAR was 72.8 ± 8.3 compared with 68.3 ± 13.9 for TEVAR ( P = .02). More women underwent TEVAR (30.6% vs 11.1%, P < .001). Aneurysms undergoing TEVAR were larger than those for EVAR (62.0 mm vs 58.3 mm, P = .01). Intraoperatively, EVAR required 26.2 minutes of fluoroscopy compared with 22.1 minutes for TEVAR ( P < .001). The amount of contrast used was higher in TEVAR (133.6 mL vs 93.6 mL, P < .001). The mean procedure times were 164 minutes for EVAR and 115 minutes for TEVAR ( P < .001). Iliac conduits were required in 46 patients (10.2%) undergoing EVAR, and in 24 (19.8%) undergoing TEVAR ( P = .007). The 30-day or in-hospital mortality was 2.0% for EVAR and 5.0% for TEVAR ( P = NS). The median length of stay was longer for TEVAR (3 days vs 2 days, P = .034). There were 54 postoperative complications in 36 TEVAR patients (29.8%), including 13 neurologic (10.7%), 8 renal (6.6%), 7 pulmonary (5.8%), 6 ischemic (5.0), and 5 (4.1%) hemorrhagic events. Among the EVAR group, 136 (30.2%) patients had postoperative complications, which included 45 ischemic (10.0%), 34 wound (7.6%), 22 renal (4.9%), 12 cardiac (2.7%), 8 pulmonary (1.8%), 5 gastrointestinal (1.1%), and 4 neurologic (0.9%) events. Conclusions A relatively higher proportion of women underwent TEVAR than EVAR, and this was reflected in the greater need for iliac conduits to accommodate the larger delivery catheters of the thoracic devices. Intraoperative imaging techniques were also different, and TEVAR required higher contrast volumes despite shorter overall procedure times. The incidence of strokes and spinal cord ischemia was also higher during TEVAR. Despite apparent similarities of devices and techniques, EVAR and TEVAR are fundamentally different procedures with different perioperative outcomes.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2006.09.012</identifier><identifier>PMID: 17210388</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - surgery ; Aortic Aneurysm, Thoracic - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Diseases of the aorta ; Endoscopy - methods ; Female ; Follow-Up Studies ; Humans ; Intraoperative Period ; Male ; Medical sciences ; Middle Aged ; Retrospective Studies ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Vascular Surgical Procedures - methods</subject><ispartof>Journal of vascular surgery, 2007, Vol.45 (1), p.86-89</ispartof><rights>The Society for Vascular Surgery</rights><rights>2007 The Society for Vascular Surgery</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c545t-5243f378f61e35a374bd6eb612c709fd95344fa6ae8d4aceb711f4f5d9bc27d53</citedby><cites>FETCH-LOGICAL-c545t-5243f378f61e35a374bd6eb612c709fd95344fa6ae8d4aceb711f4f5d9bc27d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521406016399$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19961625$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17210388$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feezor, Robert J., MD</creatorcontrib><creatorcontrib>Huber, Thomas S., MD, PhD</creatorcontrib><creatorcontrib>Martin, Tomas D., MD</creatorcontrib><creatorcontrib>Beaver, Thomas M., MD</creatorcontrib><creatorcontrib>Hess, Philip J., MD</creatorcontrib><creatorcontrib>Klodell, Charles T., MD</creatorcontrib><creatorcontrib>Nelson, Peter R., MD</creatorcontrib><creatorcontrib>Berceli, Scott A., MD, PhD</creatorcontrib><creatorcontrib>Seeger, James M., MD</creatorcontrib><creatorcontrib>Lee, W. Anthony, MD</creatorcontrib><title>Perioperative differences between endovascular repair of thoracic and abdominal aortic diseases</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Background With the US Food and Drug Administration approval of the TAG thoracic device, more thoracic pathologies are being treated using endovascular techniques. Although endovascular abdominal and thoracic aortic repairs have some apparent similarities, there are substantive anatomic, pathologic, and technical differences that could impact perioperative outcomes. The purpose of this study is to identify these differences. Methods During a 5-year period, 121 endovascular thoracic aortic repairs (TEVAR) and 450 abdominal aortic repairs (EVAR) were performed at a single institution. Preoperative, intraoperative, and early postoperative data were prospectively collected and retrospectively reviewed. Aggregate outcome measures were compared between the two cohorts, with statistical significance achieved at P < .05. Results The mean age of patients undergoing EVAR was 72.8 ± 8.3 compared with 68.3 ± 13.9 for TEVAR ( P = .02). More women underwent TEVAR (30.6% vs 11.1%, P < .001). Aneurysms undergoing TEVAR were larger than those for EVAR (62.0 mm vs 58.3 mm, P = .01). Intraoperatively, EVAR required 26.2 minutes of fluoroscopy compared with 22.1 minutes for TEVAR ( P < .001). The amount of contrast used was higher in TEVAR (133.6 mL vs 93.6 mL, P < .001). The mean procedure times were 164 minutes for EVAR and 115 minutes for TEVAR ( P < .001). Iliac conduits were required in 46 patients (10.2%) undergoing EVAR, and in 24 (19.8%) undergoing TEVAR ( P = .007). The 30-day or in-hospital mortality was 2.0% for EVAR and 5.0% for TEVAR ( P = NS). The median length of stay was longer for TEVAR (3 days vs 2 days, P = .034). There were 54 postoperative complications in 36 TEVAR patients (29.8%), including 13 neurologic (10.7%), 8 renal (6.6%), 7 pulmonary (5.8%), 6 ischemic (5.0), and 5 (4.1%) hemorrhagic events. Among the EVAR group, 136 (30.2%) patients had postoperative complications, which included 45 ischemic (10.0%), 34 wound (7.6%), 22 renal (4.9%), 12 cardiac (2.7%), 8 pulmonary (1.8%), 5 gastrointestinal (1.1%), and 4 neurologic (0.9%) events. Conclusions A relatively higher proportion of women underwent TEVAR than EVAR, and this was reflected in the greater need for iliac conduits to accommodate the larger delivery catheters of the thoracic devices. Intraoperative imaging techniques were also different, and TEVAR required higher contrast volumes despite shorter overall procedure times. The incidence of strokes and spinal cord ischemia was also higher during TEVAR. Despite apparent similarities of devices and techniques, EVAR and TEVAR are fundamentally different procedures with different perioperative outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Diseases of the aorta</subject><subject>Endoscopy - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vascular Surgical Procedures - methods</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kVGL1DAUhYMo7jj6A3yRvujbjLltmjQIgiy6CgsK6nNIkxtM7TRjbjuy_96UGVjYB58C4ZyTk-8w9hL4HjjIt8N-ONG-5lzuud5zqB-xDXCtdrLj-jHbcCVg19YgrtgzooFzgLZTT9kVqBp403UbZr5hjumI2c7xhJWPIWDGySFVPc5_EacKJ59Oltwy2lxlPNqYqxSq-VfK1kVX2clXtvfpECc7VjbluVz6SGgJ6Tl7EuxI-OJybtnPTx9_XH_e3X69-XL94XbnWtHOpaRoQqO6IAGb1jZK9F5iL6F2iuvgddsIEay02HlhHfYKIIjQet27Wvm22bI359xjTn8WpNkcIjkcRzthWsjITkCryqe3DM5ClxNRxmCOOR5svjPAzUrVDKZQNStVw7UpVIvn1SV86Q_o7x0XjEXw-iIonOwYsp1cpHud1hJkvbZ8d9ZhQXGKmA25uNL2MaObjU_xvzXeP3C7MU6xPPgb75CGtOSyABkwVBtuvq_zr-tzWfIarZt_UBmrhQ</recordid><startdate>2007</startdate><enddate>2007</enddate><creator>Feezor, Robert J., MD</creator><creator>Huber, Thomas S., MD, PhD</creator><creator>Martin, Tomas D., MD</creator><creator>Beaver, Thomas M., MD</creator><creator>Hess, Philip J., MD</creator><creator>Klodell, Charles T., MD</creator><creator>Nelson, Peter R., MD</creator><creator>Berceli, Scott A., MD, PhD</creator><creator>Seeger, James M., MD</creator><creator>Lee, W. Anthony, MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2007</creationdate><title>Perioperative differences between endovascular repair of thoracic and abdominal aortic diseases</title><author>Feezor, Robert J., MD ; Huber, Thomas S., MD, PhD ; Martin, Tomas D., MD ; Beaver, Thomas M., MD ; Hess, Philip J., MD ; Klodell, Charles T., MD ; Nelson, Peter R., MD ; Berceli, Scott A., MD, PhD ; Seeger, James M., MD ; Lee, W. Anthony, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c545t-5243f378f61e35a374bd6eb612c709fd95344fa6ae8d4aceb711f4f5d9bc27d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Diseases of the aorta</topic><topic>Endoscopy - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vascular Surgical Procedures - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feezor, Robert J., MD</creatorcontrib><creatorcontrib>Huber, Thomas S., MD, PhD</creatorcontrib><creatorcontrib>Martin, Tomas D., MD</creatorcontrib><creatorcontrib>Beaver, Thomas M., MD</creatorcontrib><creatorcontrib>Hess, Philip J., MD</creatorcontrib><creatorcontrib>Klodell, Charles T., MD</creatorcontrib><creatorcontrib>Nelson, Peter R., MD</creatorcontrib><creatorcontrib>Berceli, Scott A., MD, PhD</creatorcontrib><creatorcontrib>Seeger, James M., MD</creatorcontrib><creatorcontrib>Lee, W. Anthony, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feezor, Robert J., MD</au><au>Huber, Thomas S., MD, PhD</au><au>Martin, Tomas D., MD</au><au>Beaver, Thomas M., MD</au><au>Hess, Philip J., MD</au><au>Klodell, Charles T., MD</au><au>Nelson, Peter R., MD</au><au>Berceli, Scott A., MD, PhD</au><au>Seeger, James M., MD</au><au>Lee, W. Anthony, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative differences between endovascular repair of thoracic and abdominal aortic diseases</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2007</date><risdate>2007</risdate><volume>45</volume><issue>1</issue><spage>86</spage><epage>89</epage><pages>86-89</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Background With the US Food and Drug Administration approval of the TAG thoracic device, more thoracic pathologies are being treated using endovascular techniques. Although endovascular abdominal and thoracic aortic repairs have some apparent similarities, there are substantive anatomic, pathologic, and technical differences that could impact perioperative outcomes. The purpose of this study is to identify these differences. Methods During a 5-year period, 121 endovascular thoracic aortic repairs (TEVAR) and 450 abdominal aortic repairs (EVAR) were performed at a single institution. Preoperative, intraoperative, and early postoperative data were prospectively collected and retrospectively reviewed. Aggregate outcome measures were compared between the two cohorts, with statistical significance achieved at P < .05. Results The mean age of patients undergoing EVAR was 72.8 ± 8.3 compared with 68.3 ± 13.9 for TEVAR ( P = .02). More women underwent TEVAR (30.6% vs 11.1%, P < .001). Aneurysms undergoing TEVAR were larger than those for EVAR (62.0 mm vs 58.3 mm, P = .01). Intraoperatively, EVAR required 26.2 minutes of fluoroscopy compared with 22.1 minutes for TEVAR ( P < .001). The amount of contrast used was higher in TEVAR (133.6 mL vs 93.6 mL, P < .001). The mean procedure times were 164 minutes for EVAR and 115 minutes for TEVAR ( P < .001). Iliac conduits were required in 46 patients (10.2%) undergoing EVAR, and in 24 (19.8%) undergoing TEVAR ( P = .007). The 30-day or in-hospital mortality was 2.0% for EVAR and 5.0% for TEVAR ( P = NS). The median length of stay was longer for TEVAR (3 days vs 2 days, P = .034). There were 54 postoperative complications in 36 TEVAR patients (29.8%), including 13 neurologic (10.7%), 8 renal (6.6%), 7 pulmonary (5.8%), 6 ischemic (5.0), and 5 (4.1%) hemorrhagic events. Among the EVAR group, 136 (30.2%) patients had postoperative complications, which included 45 ischemic (10.0%), 34 wound (7.6%), 22 renal (4.9%), 12 cardiac (2.7%), 8 pulmonary (1.8%), 5 gastrointestinal (1.1%), and 4 neurologic (0.9%) events. Conclusions A relatively higher proportion of women underwent TEVAR than EVAR, and this was reflected in the greater need for iliac conduits to accommodate the larger delivery catheters of the thoracic devices. Intraoperative imaging techniques were also different, and TEVAR required higher contrast volumes despite shorter overall procedure times. The incidence of strokes and spinal cord ischemia was also higher during TEVAR. Despite apparent similarities of devices and techniques, EVAR and TEVAR are fundamentally different procedures with different perioperative outcomes.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>17210388</pmid><doi>10.1016/j.jvs.2006.09.012</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Aortic Aneurysm, Abdominal - surgery Aortic Aneurysm, Thoracic - surgery Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Diseases of the aorta Endoscopy - methods Female Follow-Up Studies Humans Intraoperative Period Male Medical sciences Middle Aged Retrospective Studies Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vascular Surgical Procedures - methods |
| title | Perioperative differences between endovascular repair of thoracic and abdominal aortic diseases |
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