Surgeon Volume Affects Technical Success and Subsequent Outcomes following Complex Endovascular Aneurysm Repair

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Aneurysm Treatment

Background:

• Complex endovascular abdominal aortic aneurysm (AAA) repairs are increasing, but complication rates and technical success vary.
• The impact of surgeon volume on managing intra-operative complications in these procedures is not well understood.

Purpose of the Study:

• To analyze factors associated with technical success in complex endovascular AAA repairs.
• To investigate the relationship between surgeon volume and technical success rates.
• To assess the impact of technical failures on patient outcomes and the role of surgeon experience.

Main Methods:

• Analysis of 6,556 complex AAA repairs (para/juxtarenal and thoraco-abdominal) from the Vascular Quality Initiative (2014-2023).
• Multilevel logistic regression with inverse probability weighting to identify predictors of technical success.
• Definition of technical success included graft placement, target vessel incorporation, and absence of major endoleaks (Type I/III).

Main Results:

• Overall technical success rate was 82.7%, with failures attributed to Type I/III endoleaks (9.6%), target vessel issues (5.6%), and main body complications (4.0%).
• Higher surgeon volume correlated with increased technical success and better outcomes, including reduced peri-operative death.
• Technical failure significantly increased risks of death, major adverse events, acute kidney injury, dialysis, spinal cord ischemia, and re-operation, with higher volume surgeons showing better mitigation.

Conclusions:

• Technical success is strongly linked to improved outcomes in complex endovascular AAA repair, particularly in non-elective cases.
• Higher volume surgeons demonstrate superior technical success rates and are better equipped to manage technical failures.
• Centralizing complex and urgent AAA repairs with high-volume surgeons may improve patient outcomes and reduce mortality.