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The Journal of Cardiovascular Surgery 2020 February;61(1):18-23

DOI: 10.23736/S0021-9509.19.11146-9


lingua: Inglese

Cost-effectiveness analysis of chimney/snorkel versus fenestrated endovascular repair for high-risk patients with complex abdominal aortic pathologies

Gergana T. TANEVA 1 , Konstantinos P. DONAS 1, Georgios A. PITOULIAS 2, Martin AUSTERMANN 1, Frank J. VEITH 3, Giovanni TORSELLO 1

1 Department of Vascular and Endovascular Surgery, St. Franziskus Hospital, Münster, Germany; 2 Second Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3 Department of Surgery, New York University, New York, NY, USA

BACKGROUND: The aim of this study was to evaluate the cost-effectiveness of chimney (ch-EVAR) vs. fenestrated aneurysm repair (f-EVAR) for treatment of complex abdominal aortic pathologies. Endovascular repair of complex abdominal aortic pathologies with involvement of renal arteries includes use of f-EVAR as first line treatment. However, lack of availability and suitability has necessitated an alternative strategy employing parallel or snorkel/chimney grafts (ch-EVAR).
METHODS: Between January 2013 and January 2017, prospectively collected data of elective and symptomatic patients with complex aortic pathologies treated by single or double ch-EVAR (N.=111) or by f-EVAR with three fenestrations (N.=37) were evaluated. The primary endpoint was cost-effectiveness analysis defined as the summary of material costs, in-hospital costs and additional costs due to procedure-related reinterventions during a follow-up period averaging 37.2 months.
RESULTS: No differences between both groups were found in terms of demographics (P=0.32), age (P=0.058) and hospital stay at initial procedure (P=0.956). Index procedure and hospitalization median costs were € 22,171 for ch-EVAR and € 42,116 for f-EVAR, respectively (P<0.001). The median overall costs including costs after reinterventions during follow-up were € 22,872 for ch-EVAR and € 42,128 for f-EVAR (P<0.001). Six patients (5.4%) in the ch-EVAR group required readmission compared to three patients (8.1%) required readmission for reinterventions in the f-EVAR group (P=0.69).
CONCLUSIONS: Ch-EVAR is significantly more cost-effective compared to f-EVAR. The two procedures have comparable readmission rates for reinterventions.

KEY WORDS: Endovascular procedures; Abdominal aortic aneurysm; Costs and cost analysis

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