Institutional differences in endovascular aneurysm repair and aneurysm morphology

Area of Science:

• Vascular Surgery
• Medical Imaging
• Comparative Effectiveness Research

Background:

• Significant institutional variability exists in the application of endovascular aneurysm repair (EVAR).
• This study addresses this by comparing patient-specific variables between a high-volume North American center and a UK institution.

Purpose of the Study:

• To compare patient and aneurysm characteristics between American and British cohorts undergoing treatment for intact infrarenal aortic aneurysms.
• To investigate potential anatomical factors contributing to differing EVAR utilization rates.

Main Methods:

• A comparative analysis of 100 consecutive patients from each of two institutions (North America and UK).
• Patient demographics and aneurysm morphology were assessed using computed tomography (CT) scans.
• Measurements followed Society for Vascular Surgery (USA) reporting standards.

Main Results:

• British patients presented with significantly larger mean aneurysm diameters (64 mm vs. 55 mm) and more angulated aneurysms (>60° in 22% vs. 11%).
• The infrarenal aortic neck was shorter (mean 21 mm vs. 25 mm) and common iliac arteries were larger in the British cohort.
• All American patients received EVAR, whereas only 11% of British patients did.

Conclusions:

• British patients exhibit a more advanced pattern of aortic aneurysm morphology compared to their American counterparts.
• These morphological differences may partially explain the observed variability in EVAR application between the two countries.