For more information about what an AAA is, diagnosis, and treatment, please click here.
Advanced Technology - EVAR (EndoVascular Aneurysm Repair)
EVAR is a procedure in which a stent (a wire mesh tube-like structure) is inserted into the aorta (the artery that carries blood from the heart to the rest of the body) through an incision in the groin. Since its introduction in 1991, EVAR has become widely used for AAA repairs. According to an article inVascular Disease Management , 40 percent of all elective AAA repairs in 2003 were endovascular. Due to differences in anatomy, fewer women are candidates for EVAR.
Because EVAR is much less invasive (the incision is much smaller and less penetrating) than traditional open repair, it has been shown to have more short-term benefits, such as decreased length of hospitalization, reduced intensive care unit stays, less blood loss, fewer major complications, and faster recovery. However, the long-term durability and effectiveness of EVAR has not been definitively proved by clinical studies. EVAR remains a viable surgical option for AAA repair with fewer short-term risks, such as excessive blood loss and the need for transfusion, than open AAA repair. To determine whether or not EVAR is an option for you, check with your physician.
EVAR was used in 63.6% of AAA repairs at BWH in the 12-month period ending 6/30/08.
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Annual AAA Repair Procedure Volume
The Leapfrog Group, a national organization devoted to improving patient safety, has suggested that a surgical program that performs at least 50 AAA repairs per year has better outcomes than programs performing fewer procedures.
Brigham and Women's Hospital’s surgeons performed 91 AAA repair procedures in the 12-month period ending 06/30/08.
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Inpatient Mortality Rate for AAA Repair
Mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. Based on a large sample of university hospitals (data from the University Healthsystem Consortium, aka UHC), the national average mortality rate for AAA repair is1.97%. Because BWH patients are generally more sick than the average patient, expected mortality rate for AAA repair is 4.91% (as estimated by UHC).
The inpatient mortality rate for heart failure at Brigham and Women's Hospital is 2.22%, which is not significantly different than both the national observed and expected rates. All rates refer to the 12-month period ending 6/30/08.
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Vascular Surgeon Availability for AAA Repair
The Dartmouth Atlas of Vascular Health Care found that, in a nationwide sample of Medicare patients undergoing vascular surgery, vascular surgeons performed 39 percent of all elective (non-emergency) AAA repairs, versus 33 percent for cardiothoracic surgeons and 28 percent for general surgeons. Vascular surgeons as a group had a lower 30-day mortality rate than the cardiothoracic and general surgeons. In addition, as a group, vascular surgeons performed more elective AAA repairs per individual surgeon than did the other two groups (Journal of Vascular Surgery, October 2002: 34(4); 751-756). Other studies, using patient data from Ontario, Canada and Florida, have found similar results (Journal of Vascular Surgery, March 2001: 33(3); 447-452).
Brigham and Women's Hospital has eight board-certified vascular surgeons on staff.
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