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Post-endovascular aneurysm repair patient outcomes and follow-up are not adversely impacted by long travel distance to tertiary vascular surgery centers.

Abstract：

BACKGROUND:To determine whether patient adherence to follow-up and patient outcomes after endovascular aneurysm repair (EVAR) are affected by the distance between a patient's residence and a tertiary care treatment center. METHODS:A retrospective review of 136 consecutive patients undergoing EVAR at the New Mexico Veterans Affairs Medical Center over a 7-year period was conducted. Patients were stratified as living within a 100-mi radius of the treatment center (group 1) and those living outside this radius (group 2). Follow-up included clinic visits and computed tomography scans at 1 month after discharge, every 6 months for 2 years, and then yearly. Incomplete follow-up was defined if two or more consecutive appointments were missed. Survival and graft-related complication rates were analyzed for both the patient groups. RESULTS:Of the 136 patients, 10 patients died from nonaneurysm-related causes less than 1 year after their EVAR procedures, and hence were not a part of the study. Of the surviving patients, 44% lived within a 100-mi radius of the treatment center (group 1), and 56% outside this 100-mi radius (group 2). The mean patient follow-up time was 52.1 ± 25.9 months. Of the surviving patients, 15% had inadequate follow-up, yet there was no significant difference in the adequacy of follow-up for patients in group 1 compared with group 2. The incidence of major complications, defined as aneurysm rupture, conversion to open repair, myocardial infarction, and stroke, was not statistically different in group 1 versus group 2 (5.0% vs. 11.8%, p = 0.23). Of the five patients (3.7%) who died as a result of abdominal aortic aneurysms related causes, three were in group 1 and two in group 2. CONCLUSIONS:Distance from a tertiary care center is not a limiting factor in patient adherence to follow-up, patient graft-related morbidity, or patient survival, likely because of the Albuquerque VA Medical Center's electronic tracking of patients and provision of travel vouchers.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Sarangarm D,Knepper J,Marek J,Biggs KL,Robertson D,Langsfeld M

doi

10.1016/j.avsg.2010.05.009

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

1075-81

issue

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(10)00261-X

journal_volume

pub_type

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Post-endovascular aneurysm repair patient outcomes and follow-up are not adversely impacted by long travel distance to tertiary vascular surgery centers.