Research Article

Comparison Outcomes of Anesthesia and Hospitalization of Endovascular Treatment versus Open Surgery for Infra Renal Abdominal Aortic Aneurysm at Sina Hospital from 2011 to 2019

Abstract

Background: Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm surgery, and endovascular aneurysm repair (EVAR). The purpose of this article is to investigate and compare the outcomes of all cases of open surgery versus EVAR conducted from2011 to 2019 at Sina Medical Research and Training Hospital, the first EVAR was conducted at Sina Hospital in 2011.
Methods: This research is a retrospective cross-sectional study. The study population consisted of all abdominal aortic aneurysm patients who were treated at Sina Hospital in Tehran from September 2011 to December 2019. All patients who met the inclusion criteria participated in the study. A checklist of required data was prepared and used to extract data from patients' medical case files. Patients' information was completed via telephone contact with patients or their families. Analyses were performed using SPSS software with a 5-percent error rate.
Results: The sample consisted of 194 patients who were divided into two groups. 73 patients (37.6%) underwent open surgery and 121 patients (62.4%) underwent EVAR. All patients (100%) who underwent open surgery received general anesthesia, while only 15 patients (12.8%) who underwent EVAR received general anesthesia, and 102 patients (87.2%) who underwent EVAR received spinal anesthesia. Rates of blood loss and blood transfusion, length of stay in the intensive care unit (ICU), the total length of postoperative hospitalization for patients who underwent open surgery were significantly higher than for those who underwent EVAR (P-value <0.001). The mortality probability of patients with a history of CVA and smoking was3.47 and 2.66 times higher than those with a negative history of these cases, respectively. Although average EF was higher in living patients compared to deceased ones, this difference was not statistically significant (P-value= 0.161).
Conclusion: Surgery duration, length of stay in ICU, length of hospital stay, and rate of blood transfusion of patients undergoing EVAR was reduced in comparison with those undergoing open surgery.

[1] Singh K, Bønaa KH, Jacobsen BK, Bjørk L, Solberg S. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: The Tromsø Study. Am J Epidemiol. 2001; 154(3):236-44.
[2] Gloviczki P, Pairolero P, Welch T, Cherry K, Hallett J, Toomey B, et al. Multiple aortic aneurysms: the results of surgical management. J Vasc Surg. 1990; 11(1|):19-27.
[3] Lederle FA, Johnson GR, Wilson SE, Chute EP, Hye RJ, Makaroun MS, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med. 2000;160(10):1425–30.
[4] Lederle FA, Johnson GR, Wilson SE; Aneurysm Detection and Management Veterans Affairs Cooperative Study. Abdominal aortic aneurysm in women. J Vasc Surg. 2001; 34(1):122-6.
[5] Takayama T, Yamanouchi D. Aneurysmal disease: the abdominal aorta. Surg Clin North Am. 2013; 93(4):877-91.
[6] Martin MC, Giles KA, Pomposelli FB, Hamdan AD, Wyers MC, Schermerhorn ML. National outcomes after open repair of abdominal aortic aneurysms with visceral or renal bypass. Ann Vasc Surg. 2010; 24(1):106–112.
[7] Kurzencwyg D, Filion KB, Pilote L, Nault P, Platt RW, Rahme E, et al. Cardiac medical therapy among patients undergoing abdominal aortic aneurysm repair. Ann Vasc Surg. 2006; 20(5):569-76.
[8] Nathan DP, Brinster CJ, Jackson BM, Wang GJ, Carpenter JP, Fairman RM, et al. Predictors of decreased short- and long-term survival following open abdominal aortic aneurysm repair. J Vasc Surg. 2011; 54(5):1237-43.
[9] Bjorck M, Troëng T, Bergqvist D. Risk factors for intestinal ischaemia after aortoiliac surgery: a combined cohort and case-control study of 2824 operations. Eur J Vasc Endovasc Surg. 1997; 13:531–539.
[10] Becquemin JP, Majewski M, Fermani N, Marzelle J, Desgrandes P, Allaire E, et al. Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair. J Vasc Surg. 2008; 47(2):258–263
[11] Davenport DL, Xenos ES. Deep venous thrombosis after repair of non ruptured abdominal aneurysm. J Vasc Surg. 2013; 57(3):678-83.
[12] Richards JM, Nimmo AF, Moores CR, Hansen PA, Murie JA, Chalmers RTA. Contemporary results for open repair of suprarenal and type IV thoracoabdominal aortic aneurysms. Br J Surg. 2010; 97(1):45-9.
[13] Jean-Baptiste E, Brizzi S, Bartoli MA, Sadaghianloo N, Baqué J, Magnan PE, et al. Pelvic ischemia and quality of life scores after interventional occlusion of the hypogastric artery in patients undergoing endovascular aortic aneurysm repair. J Vasc Surg. 2014; 60(1):40-9.
[14] Jordan WD Jr, Moore WM Jr, Melton JG, Brown OW, Carpenter JP; Endologix Investigators. Secure fixation following EVAR with the Powerlink XL system in wide aortic necks: results of a prospective, multicenter trial. J Vasc Surg. 2009; 50(5):979-86.
[15] Albuquerque Jr FC, Tonnessen BH, Noll Jr RE, Cires G, Kim JK, Sternbergh WC. Paradigm shifts in the treatment of abdominal aortic aneurysm: trends in 721 patients between 1996 and 2008. J Vasc Surg. 2010; 51:1348-52.
[16] Lovegrove RE, Javid M, Magee TR, Galland RB. A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg. 2008; 95(6):677-84.
[17] Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364(9437):843-8.
[18] Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004; 351(16):1607-18.
[19] England A, Mc Williams R. Endovascular aortic aneurysm repair (EVAR). Ulster Med J. 2013; 82(1):3-10.
[20] Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT Jr, Kohler TR, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012; 367(21):1988-97.
[21] Asakura Y, Ishibashi H, Ishiguchi T, Kandatsu N, Akashi M, Komatsu T. General versus locoregional anesthesia for endovascular aortic aneurysm repair: influences of the type of anesthesia on its outcome. J Anesth. 2009; 23(1):158-61.
[22] Ruppert V, Leurs LJ, Steckmeier B, Buth J, Umscheid T. Influence of anesthesia type on outcome after endovascular aortic aneurysm repair: an analysis based on EUROSTAR data J Vasc Surg. 2006; 44(1):16-21.
[23] Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009; 302(14):1535-42.
[24] Lederle FA, Johnson GR, Wilson SE; Aneurysm Detection and Management Veterans Affairs Cooperative Study. Abdominal aortic aneurysm in women. J Vasc Surg. 2001; 34(1):122-6.
[25] Yang JH, Kim JW, Choi HC, Park HO, Jang IS, Lee CE, et al. Comparison of Clinical Outcomes between Surgical Repair and Endovascular Stent for the Treatment of Abdominal Aortic Aneurysm. Vasc Specialist Int. 2017; 33(4):140-145.
[26] García-Madrid C, Josa M, Riambau V, Mestres CA, Muntaña J, Mulet J. Endovascular versus open surgical repair of abdominal aortic aneurysm: a comparison of early and intermediate results in patients suitable for both techniques. Eur J Vasc Endovasc Surg. 2004; 28(4):365-72.
[27] Moore WS, Kashyap VS, Vescera CL, Quiñones-Baldrich WJ. Abdominal aortic aneurysm: a 6-year comparison of endovascular versus transabdominal repair. Ann Surg. 1999; 230(3):298-306.
[28] Shiels H, Desmond AN, Parimkayala R, Cahill J. The impact of abdominal aortic aneurysm surgery on intensive care unit resources in an Irish tertiary centre. Ir J Med Sci. 2013; 182(3):371-5.
[29] Bakker EJ, van de Luijtgaarden KM, van Lier F, Valentijn TM, Hoeks SE, Klimek M, et al. General anaesthesia is associated with adverse cardiac outcome after endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2012; 44(2):121-5.
[30] Ruppert V, Leurs LJ, Rieger J, Steckmeier B, Buth J, Umscheid T. Risk-adapted outcome after endovascular aortic aneurysm repair: analysis of anesthesia types based on EUROSTAR data. J Endovasc Ther. 2007; 14(1):12-22.
[31] Lindholt JS, Jørgensen B, Shi GP, Henneberg EW. Relationships between activators and inhibitors of plasminogen, and the progression of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2003; 25(6):546-51.
[32] Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010; 52(3):539-48.
[33] Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance: UK Small Aneurysm Trial Participants. Ann Surg. 1999; 230(3):289-96.
[34] Lottman PE, Van Marrewijk CJ, Fransen GA, Laheij RJ, Buth J. Impact of smoking on endovascular abdominal aortic aneurysm surgery outcome. Eur J Vasc Endovasc Surg. 2004; 27(5):512-8.
[35] Koole D, Moll FL, Buth J, Hobo R, Zandvoort H, Pasterkamp G, et al. The influence of smoking on endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2012; 55(6):1581-6.
Files
IssueVol 6 No 4 (2020): Autumn QRcode
SectionResearch Article(s)
Published2020-11-22
DOI https://doi.org/10.18502/aacc.v6i4.4630
Keywords
Anesthesia Hospitalization Endovascular treatment Open surgery Renal abdominal Hospital

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Salimi J, Nazari MS, Moini M, Cheraghali R, Rahimpour E, Zabihi Mahmoudabadi H, Farshidmehr P. Comparison Outcomes of Anesthesia and Hospitalization of Endovascular Treatment versus Open Surgery for Infra Renal Abdominal Aortic Aneurysm at Sina Hospital from 2011 to 2019. Arch Anesth & Crit Care. 6(4):188-93.