Background: Emergency endovascular aneurysm repair (eEVAR) for infrarenal abdominal aortic aneurysm has become widely accepted as an alternative to open repair, if the aortic anatomy is favorable and endovascular expertise is readily available. The aim of this study is to report the outcome of eEVAR in Hong Kong.
Methods: This was a retrospective review of prospectively collected data from Hong Kong Hospital Authority Clinical Data Analysis and Reporting System (CDARS), Clinical Management System (CMS), and departmental prospective computerized databases. Patient demographics, clinical and biochemical parameters, perioperative complications, and outcomes were recorded and analyzed. The independent sample t-test was used for continuous variables and the Fisher's exact test was used for nonparametric variables. Kaplan-Meier analysis was performed for overall survival and survival of subgroups. Binary logistic regression was performed for factors predicting perioperative mortality. SPSS software (version 15.0; SPSS Inc., Chicago, IL) was used for all statistical analyses.
Results: A total of 40 patients (36 men with a mean age of 74.9 ± 1.53 years [range: 52-89 years]) underwent emergency eEVAR between January 2006 and September 2011 in 6 Hospital Authority Hospitals in Hong Kong. All patients were treated using commercially available aortoiliac endografts (including 26 bifurcated and 14 aorto-uniiliac grafts). There was 1 conversion from eEVAR to open repair. Blood loss, operating time, duration of stay in intensive care, and duration of stay in the hospital were 948 ± 495.5 mL, 194 ± 12.7 min, 4.7 ± 1.26 days, and 14.5 ± 2.19 days, respectively. The 7-day, 30-day, and 12-month mortality rates were 15%, 17.5%, and 35%, respectively. Six patients required reintervention on follow-up, and 8 patients died during hospitalization. Cox regression analysis of survival found that hypotension (P = 0.001) and being >76 years of age (P = 0.002) were associated with reduced overall survival. Binary logistic regression found that hypotension is associated with increased 30-day mortality (P = 0.026).
Conclusions: This audit shows that the results of eEVAR in Hong Kong are comparable to international standards. In the endovascular era, this may be an attractive alternative to emergency open aneurysm repair.
Copyright © 2014 Elsevier Inc. All rights reserved.