SVS Announces Study Supporting Fully Percutaneous Approach for Repair of Ruptured AAA
November 2, 2017—The Society for Vascular Surgery (SVS) announced that findings from a comparison of percutaneous access versus femoral cutdown during endovascular repair of ruptured abdominal aortic aneurysm (AAA) were published by Samuel L. Chen, MD, et al in the Journal of Vascular Surgery (2017;66:1364–1370).
The study addresses the question of whether the fully percutaneous technique offers any benefit over open femoral cutdown in the emergency setting. Investigators reviewed a large national database and found that using an entirely percutaneous approach is as safe as incision-based approaches.
According to SVS, led by Roy M. Fujitani, MD, researchers retrospectively studied 502 patients who underwent ruptured endovascular aortic aneurysm repair and were entered into the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2014. The percentages of different endovascular repair access rates were 24% for bilateral percutaneous, 64% for bilateral femoral cutdown, 10% for unilateral femoral cutdown, and 2% for percutaneous converted to cutdown. No significant differences were observed in patient demographics or presentation in terms of hemodynamic instability.
For percutaneous (n = 129) versus cutdown (n = 373) procedures, the investigators found that operation time for percutaneous procedures was 6 minutes more than for cutdown, and length of stay was 1.3 days less for percutaneous procedures. The rates of conversion to open AAA repair were 6.2% for percutaneous and 2.1% for cutdown, wound complication rates were 4.8% for percutaneous and 5.4% for cutdown, and the 30-day mortality rates were 28.7% for percutaneous versus 20.1% for cutdown.
Additionally, the investigators reported the following trends in percutaneous repair in 2011 to 2012 versus 2013 to 2014: percent of percutaneous procedures, 14% versus 32%; operation time, 188 minutes versus 163 minutes; and 30-day mortality, 38.2% versus 25.3%, respectively.
In the SVS announcement, Dr. Chen commented, “On initial comparison, the worse mortality in the percutaneous group was surprising. However, after adjustment for various risk factors, we did not find statistically significant differences in mortality, operative time, rate of wound complications, or hospital length of stay between the two groups.” Dr. Chen further noted, “The primary outcomes of operative time and mortality significantly improved for the percutaneous group over the 4-year study period.”
These study results reveal increased use of the percutaneous approach to treat ruptured AAA, but superiority has not yet been proven over the traditional femoral cutdown approach. It also suggests improved outcomes over time, particularly among patients undergoing a percutaneous approach. This study sets an important baseline to which future comparisons can be made regarding progress toward even less invasive therapies for a lethal disease, concluded the SVS report.