SUCCESSFUL EVAR PROGRAM FOR AAA IN A RURAL HOSPITAL


Samuel M. Butman, M.D., Verde Valley Medical Center, Cottonwood, AZ, USA

Endovascular aortic aneurysm repair (EVAR) is now widely accepted as the preferred method of mitigating the risk of rupture in patients with documented abdominal aneurysms. Beginning in higher volume centers, the procedure is now performed in smaller community hospitals. This report highlights the rapid introduction and success of an EVAR program in a very small (100-bed) medical center in a small community in Northern Arizona. Since the arrival of a Board-certified vascular surgeon in late 2006 and the development of an EVAR program, the demographic, outcome and follow-up data on all 65 abdominal aneurysm interventions performed at Verde Valley Medical Center have been collected. Procedural success has been 100%, with no conversions to open repair. The median LOS has been 1.0+/-0.9 days with 2 pts readmitted within a week for short stays (1 COPD, 1 CHF). The 1 perioperative death was in a pt with an 11.5 cm ruptured AAA. During follow-up, there has been 1 type II endoleak which sealed spontaneously at 9 months, 2 pts with Type I endoleaks required repeat EVAR at 1 year, a 3rd pt had an open repair & 1 pt had occlusion of the left limb, treated with a stent graft. Three patients have died from unrelated causes in the follow up period. This report describes an ongoing successful EVAR program at a very small community hospital. Despite its size the hospital has also had a successful primary and elective coronary interventional program without onsite cardiothoracic surgical support for over 10 years with over 2500 coronary interventions performed without the need for emergency surgical intervention. While higher volume surgical centers may be associated with lower complication rates and better survival, experienced operators and well-trained support staff can also favorably impact outcomes.