Impact of endovascular repair on open aortic aneurysm surgical training

Purpose: The purpose of this study was to determine the impact of an endova scular stent-graft program on vascular training in open aortic aneurysm sur gery. Methods: The institutional and vascular surgery fellow experience in aortic aneurysm repair during a 6-year period was reviewed. The 3-year period bef ore introduction of endovascular repair was compared with the 3-year period after introduction of endovascular repairs All patients undergoing abdomin al aortic aneurysm (AAA) or thoracoabdominal aortic aneurysm repairs were e ntered prospectively into a vascular registry and retrospectively analyzed to evaluate the changing patterns in aortic aneurysm treatment and surgical training. Results: Between July 1994 and Tune 2000, a total of 588 patients with AAA or thoracoabdominal aneurysms were treated at Stanford University Medical C enter. There were 296 (50%) open infrarenal AAA repairs, 87 (15%) suprarena l AAA repairs, 47 (8%) thoracoabdominal aneurysm repairs, and 153 (26%) end ovascular stent-grafts. The total number of aneurysms repaired per year by vascular fellows before the endovascular program was 71.3 +/- 4.9 (range, 6 8-77) and increased to 124.7 +/- 35.6 (range, 91-162) after introduction of endovascular repair (P < .05). This increase was primarily caused by the a ddition of endovascular stent-graft repairs by vascular fellows (51.0 +/- 2 9.0/year [range, 23-81]). There was no change in the number of open infrare nal aortic aneurysm repairs per year, 53.0 +/- 6.6 (range 48-56) before end ovascular repair versus 47.0 +/- 1.7 (range, 46-49) after (P = not signific ant). There was a significant increase in the number of suprarenal AAA repa irs per year by vascular fellows, 10.0 +/- 1.0 (range, 9-11) before endovas cular repair compared with 19.0 +/- 6.5 (range, 13-26) after (P < .05). The re was no change in the number of thoracoabdominal aneurysm repairs per yea r between the two groups, 8.0 +/- 3.0 (range, 4-11) before endovascular rep air compared with 7.6 +/- 2.3 (range, 5-9) after. Conclusions: Introduction of an endovascular aneurysm stent-graft program s ignificantly increased the total number of aneurysms treated. Although the number of open aneurysm repairs has remained the same, the complexity of th e open aneurysm experience has increased significantly for vascular fellows in training.