NESVS 2022: Study illustrates relationship between increased distance from medical center and higher treatment costs among complex aortic patients

Zach. M. Feldman at NESVS 2022

Research detailing that patients traveling farther for complex aortic surgery have higher procedural costs, postoperative imaging costs, and comprehensive one-year costs was among the new science being presented at the 2022 annual meeting of the New England Society for Vascular Surgery (NESVS) in Newport, Rhode Island (Oct. 14–16). 

Investigators, including first-named author Zach M. Feldman, MD, a vascular surgery resident at Massachusetts General Hospital in Boston, and senior author Mark F. Conrad, MD, drew this conclusion after conducting a retrospective review of all patients in the Vascular Quality Initiative (VQI) and Vascular Implant Surveillance and Interventional Outcomes Network (VISION) databases undergoing complex endovascular aortic repair (EVAR). The paper won the NESVS’ 2022 R. Clement Darling Award.

Between 2011 and 2018, they looked at 8,782 patients, including 4,822 with complex EVARs, 2,672 complex thoracic EVARs (TEVARs), and 1,288 complex open abdominal aortic aneurysm (AAA) repairs. Median travel distance was 22.8 miles, with the research team establishing that patients traveling farther were more likely female and having had prior aortic surgery. 

“These patients should be targeted for increased care coordination for improved outcomes and healthcare system burden,” the researchers concluded.

Elsewhere, a team from the University of Massachusetts Medical School in Worcester led by Andres Schanzer, MD, delivered data on their initial experience with the emerging Fiber Optic RealShape (FORS) imaging technology. The findings were delivered by Eric J. Finnesgard, MD, with the paper achieving the NESVS’ 2022 Deterling Award.

They presented findings from 21 procedures carried out with FORS guidance that were matched to 63 non-FORS procedures. Ninety-five FORS cannulation tasks were attempted (87 visceral target artery, 8 contralateral bifurcated gate), they reported, with technical success achieved in 81 cannulations (85%). Furthermore, 15 (16%) were completed without any fluoroscopy, they add. “Use of FORS guidance was associated with lower median procedural and fluoroscopy times, dose area product, and air kerma.” 

Meanwhile, a team from Beth Israel Deaconess Medical Center in Boston, led by Marc Schermerhorn, MD, demonstrated use of FORS in internal iliac artery navigation in a video presentation.

“Much of the attention garnered by FORS is for use in complex aortic surgery … however, we have found that the FORS system is also particularly useful for navigation of the internal iliac artery,” they noted.

The video showed two examples of internal iliac artery navigation with the FORS wire and catheter. “Specifically, [the cases] demonstrate the ability to employ extreme angles that would either not be possible with conventional fluoroscopy or subject personnel to high radiation doses,” the team added. “These cases also demonstrate the ability to use two different fluoroscopy angles simultaneously.”


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