ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2019 June;26(2):63-9

DOI: 10.23736/S1824-4777.19.01403-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Clinical and economic impact of “Pevar-First” approach in daily practice: a single-center experience

Giuseppe BALDINO ¹ ✉, Marta BAROSSO ¹, Federica PERSI ¹, Paolo MORTOLA ¹, Giovanni DE CARO ², Amerigo GORI ¹

¹ Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy; ² Department of Interventional Radiology, Galliera Hospital, Genoa, Italy

BACKGROUND: The aim of the study was the evaluation in terms of clinical outcome and economic sustainability of a “percutaneous first” approach for elective endovascular abdominal aortic aneurysms repair (EVAR).
METHODS: Single-center retrospective study of patients undergoing elective EVAR at our institution was carried out between May 2015 and September 2017. A clinical and economical comparison between percutaneous endovascular aneurysms repair (PEVAR) and standard endovascular aneurysm repair (SEVAR) with femoral cutdown was performed. The PEVAR procedure was routinely performed at our center applying Perclose ProGlide arteriotomy closure device (ACD) using the “Preclose technique.” Percutaneous access was always ultrasound-guided.
RESULTS: The study included 116 patients (66 PEVAR, 50 SEVAR) who underwent elective EVAR. Technical access success was 100% for SEVAR accesses and 96% for PEVAR accesses. Related access complications were 6 out of 95 SEVAR accesses (2 underwent reintervention); 5 out of 125 PEVAR accesses (4 converted intraoperatively and 1 underwent reintervention). The mean duration of postoperative stay was 5.0 days for SEVAR and 2.2 days for PEVAR (P=0.003). The mean duration of intervention was 148.0 minutes for SEVAR and 105.4 minutes for PEVAR (P<0.001). Major adverse events were 6 out of 50 for SEVAR and 4 out of 66 for PEVAR; there was no mortality. According to provider perspective, use of PEVAR approach resulted in a saving of € 1647 per patient.
CONCLUSIONS: The study showed that PEVAR is a safe and effective technique and can be used in daily clinical practice. The PEVAR approach would allow a significant cost-saving for provider prospective.

KEY WORDS: Aortic aneurysm; Endovascular procedures; Cost-benefit analysis