Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

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doi:https://doi.org/10.1016/j.ejvs.2020.02.027

Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

Collaborators

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38–50) mm and 68 (IQR 58–85) mm, respectively. Mortality was 1.3% (95% CI 0.7–2.4) after eIAA repair and 25.5% (95% CI 18.0–34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

Original language	English
Pages (from-to)	49-55
Number of pages	7
Journal	European Journal of Vascular and Endovascular Surgery
Volume	60
Issue number	1
Early online date	2020
DOIs	https://doi.org/10.1016/j.ejvs.2020.02.027
Publication status	Published - Jul 2020

Keywords

Aneurysm repair
EVAR
Iliac artery aneurysm
Open repair

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https://doi.org/10.1016/j.ejvs.2020.02.027

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@article{c0429b8d9e7b422da8f0f2b4cd76b3cc,

title = "Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands",

abstract = "Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38–50) mm and 68 (IQR 58–85) mm, respectively. Mortality was 1.3% (95% CI 0.7–2.4) after eIAA repair and 25.5% (95% CI 18.0–34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.",

keywords = "Aneurysm repair, EVAR, Iliac artery aneurysm, Open repair",

author = "Collaborators and Hamid Jalalzadeh and Reza Indrakusuma and Koelemay, {Mark J.W.} and Ron Balm and {Van den Akker}, {L. H.} and {Van den Akker}, {P. J.} and Akkersdijk, {G. J.} and Akkersdijk, {G. P.} and Akkersdijk, {W. L.} and {van Andringa de Kempenaer}, {M. G.} and Arts, {C. H.} and Avontuur, {J. A.} and Baal, {J. G.} and Bakker, {O. J.} and R. Balm and Barendregt, {W. B.} and Bender, {M. H.} and Bendermacher, {B. L.} and {van den Berg}, M. and P. Berger and Beuk, {R. J.} and Blankensteijn, {J. D.} and Bleker, {R. J.} and Bockel, {J. H.} and Bodegom, {M. E.} and Bogt, {K. E.} and Boll, {A. P.} and Booster, {M. H.} and {Borger van der Burg}, {B. L.} and {de Bruin}, {J. L.} and Coveliers, {H. M.} and Hoksbergen, {A. W.} and Huisman, {L. C.} and Idu, {M. M.} and Jacobs, {M. J.} and V. Jongkind and Legemate, {D. A.} and Lensvelt, {M. M.} and Mattens, {E. C.} and Nederhoed, {J. H.} and Nieuwenhuis, {D. H.} and Stigter, {D. A.} and M. Truijers and Verhagen, {H. J.} and Vermeulen, {C. F.} and Visser, {M. J.} and {Vlijmen - van Keulen}, {C. J.} and Wiersema, {A. M.} and W. Wisselink and {van Zeeland}, {M. L.} and {de Borst}, {G. J.} and {Bos-van Rossum}, {W. T.} and J. Bosma and Botman, {J. M.} and Bouwman, {L. H.} and Breek, {J. C.} and V. Brehm and Brinckman, {M. J.} and {van den Broek}, {T. H.} and Brom, {H. L.} and {de Bruijn}, {M. T.} and P. Brummel and J. Diks and {van der Laan}, {M. J.} and Schreinemacher, {M. H.} and Cagdas {\"U}nl{\"u} and {de Vries}, M.",

year = "2020",

month = jul,

doi = "https://doi.org/10.1016/j.ejvs.2020.02.027",

language = "English",

volume = "60",

pages = "49--55",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "W.B. Saunders Ltd",

number = "1",

}

TY - JOUR

T1 - Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

AU - Collaborators

AU - Jalalzadeh, Hamid

AU - Indrakusuma, Reza

AU - Koelemay, Mark J.W.

AU - Balm, Ron

AU - Van den Akker, L. H.

AU - Van den Akker, P. J.

AU - Akkersdijk, G. J.

AU - Akkersdijk, G. P.

AU - Akkersdijk, W. L.

AU - van Andringa de Kempenaer, M. G.

AU - Arts, C. H.

AU - Avontuur, J. A.

AU - Baal, J. G.

AU - Bakker, O. J.

AU - Balm, R.

AU - Barendregt, W. B.

AU - Bender, M. H.

AU - Bendermacher, B. L.

AU - van den Berg, M.

AU - Berger, P.

AU - Beuk, R. J.

AU - Blankensteijn, J. D.

AU - Bleker, R. J.

AU - Bockel, J. H.

AU - Bodegom, M. E.

AU - Bogt, K. E.

AU - Boll, A. P.

AU - Booster, M. H.

AU - Borger van der Burg, B. L.

AU - de Bruin, J. L.

AU - Coveliers, H. M.

AU - Hoksbergen, A. W.

AU - Huisman, L. C.

AU - Idu, M. M.

AU - Jacobs, M. J.

AU - Jongkind, V.

AU - Legemate, D. A.

AU - Lensvelt, M. M.

AU - Mattens, E. C.

AU - Nederhoed, J. H.

AU - Nieuwenhuis, D. H.

AU - Stigter, D. A.

AU - Truijers, M.

AU - Verhagen, H. J.

AU - Vermeulen, C. F.

AU - Visser, M. J.

AU - Vlijmen - van Keulen, C. J.

AU - Wiersema, A. M.

AU - Wisselink, W.

AU - van Zeeland, M. L.

AU - de Borst, G. J.

AU - Bos-van Rossum, W. T.

AU - Bosma, J.

AU - Botman, J. M.

AU - Bouwman, L. H.

AU - Breek, J. C.

AU - Brehm, V.

AU - Brinckman, M. J.

AU - van den Broek, T. H.

AU - Brom, H. L.

AU - de Bruijn, M. T.

AU - Brummel, P.

AU - Diks, J.

AU - van der Laan, M. J.

AU - Schreinemacher, M. H.

AU - Ünlü, Cagdas

AU - de Vries, M.

PY - 2020/7

Y1 - 2020/7

N2 - Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38–50) mm and 68 (IQR 58–85) mm, respectively. Mortality was 1.3% (95% CI 0.7–2.4) after eIAA repair and 25.5% (95% CI 18.0–34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

AB - Objective: The new 2019 guideline of the European Society for Vascular Surgery (ESVS) recommends consideration for elective iliac artery aneurysm (eIAA) repair when the iliac diameter exceeds 3.5 cm, as opposed to 3.0 cm previously. The current study assessed diameters at time of eIAA repair and ruptured IAA (rIAA) repair and compared clinical outcomes after open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Methods: This retrospective observational study used the nationwide Dutch Surgical Aneurysm Audit (DSAA) registry that includes all patients who undergo aorto-iliac aneurysm repair in the Netherlands. All patients who underwent primary IAA repair between 1 January 2014 and 1 January 2018 were included. Diameters at time of eIAA and rIAA repair were compared in a descriptive fashion. The anatomical location of the IAA was not registered in the registry. Patient characteristics and outcomes of OSR and EVAR were compared with appropriate statistical tests. Results: The DSAA registry comprised 974 patients who underwent IAA repair. A total of 851 patients were included after exclusion of patients undergoing revision surgery and patients with missing essential variables. eIAA repair was carried out in 713 patients, rIAA repair in 102, and symptomatic IAA repair in 36. OSR was performed in 205, EVAR in 618, and hybrid repairs and conversions in 28. The median maximum IAA diameter at the time of eIAA and rIAA repair was 43 (IQR 38–50) mm and 68 (IQR 58–85) mm, respectively. Mortality was 1.3% (95% CI 0.7–2.4) after eIAA repair and 25.5% (95% CI 18.0–34.7) after rIAA repair. Mortality was not significantly different between the OSR and EVAR subgroups. Elective OSR was associated with significantly more complications than EVAR (intra-operative: 9.8% vs. 3.6%, post-operative: 34.0% vs. 13.8%, respectively). Conclusion: In the Netherlands, most eIAA repairs are performed at diameters larger than recommended by the ESVS guideline. These findings appear to support the recent increase in the threshold diameter for eIAA repair.

KW - Aneurysm repair

KW - EVAR

KW - Iliac artery aneurysm

KW - Open repair

UR - http://www.scopus.com/inward/record.url?scp=85083517477&partnerID=8YFLogxK

U2 - https://doi.org/10.1016/j.ejvs.2020.02.027

DO - https://doi.org/10.1016/j.ejvs.2020.02.027

M3 - Article

C2 - 32331994

SN - 1078-5884

VL - 60

SP - 49

EP - 55

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 1

ER -

Editor's Choice – Nationwide Analysis of Patients Undergoing Iliac Artery Aneurysm Repair in the Netherlands

Abstract

Keywords

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