Vascular Surgery Literature Summaries

Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009 Oct 14;302(14):1535-42 [PMID 19826022]

  • outcome flowing EVAR vs open repair (OR) of AAA
  • MRCT
  • primary outcomes – long term all-cause mortality
  • secondary outcomes – procedure failure, length of stay, QOL, erectile dysfunction, procedure-related morbidity.
  • n = 881
    -> higher mortality in OR group @ 30 days
    -> no different in mortality @ 2 years
    -> no other differences between groups (procedure failure, secondary therapeutic procedures, aneurysm-related hospitalisations or 1 year mortality, other morbidities)
    -> EVAR group: shorter procedure, less blood loss, lower transfusions, shorter duration of MV, shorter hospital stay, ICU stay HOWEVER, extensive fluoroscopy + exposure to contrast.-> initial short term survival advantage of EVAR was offset by the need for frequent re-intervention, repeat CT and repeat clinic visits and no difference @ 2 years.
    -> However, with increasing technology and improved techniques they will be standard of care for patients with larger aneurysms and those with IHD.

Greenhalgh, M.D., et al Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. [PMID 20382982]

  • MRCT
  • n = 404
  • endovascular repair vs no repair
  • 1999-2004
  • inclusion criteria: those physically unable to undergo open repair, age > 60, AAA > 5.5cm
  • primary end points = death from any cause, aneurysm related death, graft related complications, reinterventions
  • no differences between the groups
  • secondary end points = cost
    -> operative mortality = 7.3%
    -> aneurysm related mortality was slightly lower in the EVAR group (P = 0.02)
    -> no difference in total mortality
    -> higher graft related complications (minimal 6 months post repair)
    -> higher reintervention
    -> more cost with EVAR
    -> statins are good!

…and the follow up…

EVAR Trial Investigators. Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial. Ann Surg. 2017 Nov;266(5):713-719. [PMID 28742684]


CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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