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AORTA  HANDLING OF AORTIC AND PERIPHERAL ARTERIAL PATHOLOGIES 

The Journal of Cardiovascular Surgery 2017 April;58(2):187-93

DOI: 10.23736/S0021-9509.16.09821-9

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Is volume important in aneurysm treatment outcome?

Athanasios KATSARGYRIS 1, Chris KLONARIS 2, Eric L. VERHOEVEN 1

1 Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany; 2 Vascular Division, First Department of Surgery, Athens University Medical School, Athens, Greece


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Several studies have suggested that surgical procedures performed at high-volume centers may result in superior outcome. Technically more demanding procedures such as aortic aneurysm repair appear to demonstrate a stronger relationship with volume. The present chapter reviewed the literature using the MEDLINE database to identify studies investigating the effect of volume in aortic aneurysm repair outcomes. The great majority of studies identified shows an advantage for high-volume hospitals with regard to perioperative mortality of abdominal (AAA), thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair. A similar advantage is shown for high-volume surgeons. The volume advantage appears to be less evident for simple endovascular procedures (EVAR & TEVAR), compared to more complex endovascular (F/BEVAR) and open surgical procedures. Superior outcomes observed in high-volume hospitals are not only explained by increased surgeons’ experience, but importantly also by a more effective management of intra- and postoperative complications. Confounding factors to be taken into account are the timing of the studies in relation to positive evolution of outcomes in several high-risk procedures, and patient cohorts selected in regions with very low- and very high-volume hospitals only.


KEY WORDS: Aortic aneurysm, abdominal - Endovascular procedures - Hospitals, high-volume - Surgery

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