Abdominal aortic aneurysm treatment in Emilia Romagna region

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.