John P. Pigott

Endograft Planning without Preoperative Arteriography: A Clinical Feasibility Study:

Purpose: To investigate an alternative method of preprocedural planning for aortic endografting based solely on spiral computed tomography (CT) with 3-dimensional (3D) reconstruction without preoperative arteriography. Methods: From August 1997 to April 1998, 25 consecutive patients with abdominal aortic aneurysms (AAA) were evaluated for endovascular repair by spiral CT scans (2-mm slice thickness) and computerized 3D model construction. No additional imaging for planning was performed. The aortoiliac dimensions, thrombus load, calcification, and vessel tortuosity were measured and evaluated from the 3D model of the aortoiliac segment. These data were used for selecting the patients; the configuration, diameter, and length of the endograft; and the attachment sites for deployment. Results: Primary procedural success was 92% (23/25). All endografts were deployed as planned, and there were no conversions to open repair. Six patients required adjunctive procedures for delivery system access or for iliac aneurysm exclusion, as predicted by the 3D model. Mean procedural time was 91 minutes (range 24 to 273). Two (8%) type II (side branch) endoleaks both sealed spontaneously within 1 month. No graft-related complications or death occurred, for a 30-day technical success rate of 100%. Conclusions: This computerized 3D model provided accurate data for preoperative evaluation of the aortoiliac segment for endovascular AAA repair. Satisfactory technical outcomes for aortic endografts can be achieved without the use of preprocedural invasive imaging.

Cost comparison of aortic aneurysm endograft exclusion versus open surgical repair.

BACKGROUND Shrinking health care resources impose a requirement to evaluate new technology for cost as well as clinical effectiveness. We studied an initial clinical experience with endograft treatment (EAG) of abdominal aortic aneurysm (AAA) at the beginning of an endovascular program in comparison with open surgical repair (OSR), which had been in use for decades. METHODS From March 1997 to April 1998, the utilization of hospital resources, actual cost, clinical descriptors, and treatment outcomes were recorded for two contemporaneous groups, each having 16 consecutive patients with AAA, treated with either EAG or OSR. Subjects were not randomized; EAG treatment was based on predetermined exclusion/inclusion criteria. Statistical comparison was by either Fishers exact test or the Wilcoxon rank sum test. RESULTS There were no differences between OSR and EAG in age, gender, AAA size, smoking status, diabetes, ischemic heart disease, history of coronary artery bypass grafts, previous vascular surgery, or other comorbidity. There were no deaths in either group. Patients treated by EAG procedure had significantly lower length of hospital stay, length of stay in intensive care unit, time in operating room, and cost of operating room without graft (P <0.05). Cost of operating room with graft was less in OSR group (P <0.001). In-hospital imaging costs specific to the EAG procedure were

Carotid arterial ultrasound scan imaging: A direct approach to stenosis measurement

1,370.45 +/-

Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians

66.92 (range

Lower extremity arterial evaluation: are segmental arterial blood pressures worthwhile?

911.58 to

A multicenter experience evaluating chronic total occlusion crossing with the Wildcat catheter (the CONNECT study)

1,826.76). Total costs were not significantly different between the OSR and EAG,

Cholecystectomy in the elderly

12,714.19 +/-

Gender bias in use of venous ultrasonography for diagnosis of deep venous thrombosis

1,115.52 and

Internal Iliac Artery Occlusion Using a Stent-Graft Tunnel during Endovascular Aneurysm Repair: A New Alternative to Coil Embolization

12,904.99 +/-

Percutaneous venous valve bioprosthesis: Initial observations

494.69, respectively (P = 0.26). CONCLUSIONS Total hospital cost is not different for the two treatments studied despite differences in experience with their use. Endograft treatment utilizes significantly less hospital resources than open surgical repair. The endograft prosthesis contributes a significant cost increment that may decline with expanded use.