Results of the first 1000 infra-renal aortic aneurysms included in the Portuguese National Vascular Registry

Abstract

INTRODUCTION: The Abdominal aortic aneurysm (AAA) module of the Portuguese National Vascular Registry (RNPV) is a prospective, voluntary, population-based registry, that encompasses more than 90% of portuguese vascular departments. The aim of this study was to evaluate the results of the first 1000 infra-renal AAA included in the Portuguese RNPV. METHODS: Data were collected from November 2019 to December 2022 and analyzed for demographic aspects, treatment indication, aneurysm anatomic characteristics, type of intervention (EVAR and open surgical repair - OSR), outcome at 30-days and 1-year. EVAR and OSR were compared within elective and urgent settings. RESULTS: A total of 1122 patients were included in the period of study. After applying the exclusion criteria, we analyzed the first consecutive 1000 patients with infra-renal aneurysm submitted to EVAR or OSR, in elective or urgent settings. Elective procedures were perfomed in 79.2% of cases. Patients were predominantly male (91.8%), with a mean age of 74.1 ± 10.6 years. The overall 30-day mortality was 2.7% (EVAR 1.8% and OSR 5.9%; p=0.003). Pos- operative complications were more frequent in the OSR group, with significant repercussion in hospital length, reinterventions and early mortality. Baseline AAA diameter was identified as a predictor of 30-day mortality. Intra- hospital mortality was inversely related with the caseload of the center (p=0.032), mainly due to higher mortality in OSR (p=0.04). The center caseload did not impact the intra-hospital mortality in elective standard EVAR procedures. Urgent repair was performed in 205 patients with significantly larger AAA-diameter (70.5 ± 21.5 mm versus 57.5 ± 14.3 mm, p<0.001). The preponderance of EVAR was less pronounced comparing to OSR (53.7% versus 46.3%). The 30-day mortality rate was 34% (EVAR 28.8% and OSR 44.4%, p=0.024). A multivariate analysis identified age (p < 0.001) and 30-day pulmonary failure (p<0.001) to be independent risk factors for mortality. CONCLUSION: Vascular registries reflect real-world practice and offer the advantage of rapid feedback of current practice. Portuguese results with AAA treatment are generally favourable and comparable to existing literature from other countries in Europe and North America.

Keywords

• Abdominal aortic aneurysm
• Vascular Registry
• Quality improvement
• Validation