1. EVAR vs. OAR: One Community Hospital’s Experience Westley Smith

2. Background Abdominal Aortic Aneurysm (AAA) http://www.zenithstentgraft.com/patients/US/aaa/what/index.html

3. Methods OAR 1.Large mid-line incision 2.Aneurysm dissected 3.Graft stitched into place 4.Aorta and Iliac Sutured Pictures taken from: http://www.guidant.com/webapp/emarketing/compass/comp.jsp?lev1=proc&lev2=aaa

4. Methods EVAR 1. Small Infrainguinal Incision 2. Catheter Insertion 3. Portable C-Arm (radiography) 4. Deployment http://www.guidant.com/webapp/emarketing/compass/comp.jsp?lev1=proc&lev2=aaa http://www.llnl.gov/str/pdfs/05_00.3.pdf http://www.ziehm.com/ZiehmVision.htm Blood Flow

5. Candidacy 1.Arteriosclerosis 2.Tortuosity 3.Infrarenal neck length/diameter 4.Iliac diameter 5.Patient preference

6. Comorbidity and Demographics Note. *Between groups Pulmonary Disease measured significantly different X 2 = 13.688, p=.001 *

7. Anatomic & Demographic Comparison Surgery Demographic OAR EVAR Sample Size2872 Females / Males9 / 1911 / 61 Age ± standard deviation73 ± 8.071 ± 7.6 Surgery Anatomical Feature OAR EVAR Aneurysm Diameter (cm)5.06 ± 1.485.0 ±.88 Neck Length (cm)2.03 ± 1.261.25 ± 1.20 Neck Diameter (cm)2.49 ±.472.19 ±.40

8. The Results Surgery Perioperative Variable OAR EVAR Significance Operative Time (min)98 ± 41126 ± 57No Significance Anesthetic Time (min)240 ± 75203 ± 67No Significance Estimated Blood Loss (cc)1482 ± 1275353 ± 285p <.001 Oral Intake (days)3.87 ± 2.07.875 ±.95p <.001 Ambulation (days)4.46 ± 4.832.33 ± 2.00p =.018

9. Postoperative Results Surgery Postoperative Variable OAR EVAR Significance Morbidity17.90%3.20%χ2 = 16.5, p <.001 Mortality3.57%2.80%χ2 = 10.7, p =.005

10. Conclusions Candidates for EVAR have tolerated a less invasive procedure without sacrificing postoperative results. The current study is indicative support for the surgeon’s continuation with EVAR – given amendable anatomical characteristics, and pending the long-term results of larger trial facilities.

11. References Chuter TA, Reilly LM, Faruqui RM, Kerlan RB, Sawhney R, Canto CJ, et al. Endovascular aneurysm repair in high risk patients. J Vas Surg; 31:122-33, 2000 Marek, J: Endoluminal graft repair of AAA by vascular surgeons at a nonclinical trial center. Presented at the Peripheral Vascular Surgery Society, 11th annual winter meeting, Snowmass, Colorado, January 11-14, 2002. Moore WS: Two-year follow-up of patients with the EVT/Guidant (Ancure) bifurcated graft for endovascular AAA repair: Advantages and disadvantages of this device. Presented at the 27th Global Veith Meeting, New York City, New York, November 2000. Abraham CZ, Chuter TA, Reilly LM, Okuhn SP, Pethan LK, Kerlan RB, Sawhney R, Buck DG, Gordon RL, Messina LM, et al: Abdominal aortic aneurysm repair with the Zenith stent graft: Short to midterm results. J Vas Surg; 36:217-225, 2002. Zarins CK, White RA, Schwarten D, et al: AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical trial. J Vas Surg; 29:292-308, 1999. Hill BB, Yehuda WG, Lee WA, Arko FR, Cornelius O, Schubart PJ, Dalman RL, Harris JE, Fogarty TJ, Zarins CK, et al: Open versus endovascular AAA repair in patients who are morphological candidates for endovascular treatment. J Endovasc Ther; 9:255-261, 2002.

12. Special Thanks to: The Biology Department & Dr. Daniel McGraw and his Office Staff

13. Questions