Advertisement

Nationwide Cross-Sectional Epidemiological Analysis of 3,306 Lower Limb Peripheral Aneurysm Repairs in Brazilian Public Hospitals Between 2008 and 2019: Trends, Mortality and Costs

Published:March 08, 2022DOI:https://doi.org/10.1016/j.avsg.2022.02.028

      Background

      Although peripheral aneurysms can be limb- or life-threatening, the literature is scarce and there are only two large population-based epidemiological studies on peripheral aneurysm repair, comprising data from high-income countries only.

      Methods

      This is a retrospective cross-sectional analysis on open and endovascular peripheral aneurysm repairs performed between 2008 and 2019 in the Brazilian Public Health System, which exclusively insures more than 160 million Brazilians.

      Results

      A total of 3,306 peripheral aneurysm repairs were observed. Most patients were elderly (57.74%) and male (72.66%), and patients treated with endovascular repair were older (P = 0.008). Most repairs were emergency (59.56%) and open (93.8%), and there was an overall downward trend in procedure rates. We observed a decreasing predominance of emergency open repair over elective open repair (P < 0.001), but open repairs prevailed over endovascular procedures, with no tendency to change this predominance. Mortality rates were 3.12% and 3.67% after elective and emergency open repair, respectively, with no difference, and 0 and 4.24% for elective and emergency endovascular repair, respectively. The government reimbursed an average of $1170.05 for open PA repair and $1802.01 for endovascular repair.

      Conclusions

      We presented the largest series of the literature analyzing all 3,306 lower limb peripheral aneurysm repairs performed in public hospitals in a middle-income country. Procedure rates tended to decrease. Open repair predominated. Mortality rates ranged from 0 to 4%. Most procedures were emergency, but there was a relative increase of elective treatments over the years.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mohan I.V.
        • Stephen M.S.
        Peripheral arterial aneurysms: open or endovascular Surgery?.
        Prog Cardiovasc Dis. 2013; 56: 36-56
        • Cervin A.
        • Tjärnström J.
        • Ravn H.
        • et al.
        Treatment of popliteal aneurysm by open and endovascular Surgery: a Contemporary study of 592 procedures in Sweden.
        Eur J Vasc Endovasc Surg. 2015; 50: 342-350
        • Fioranelli A.
        • Carpentieri E.A.
        • Wolosker N.
        • et al.
        Rupture of thrombosed popliteal aneurysm: a case report.
        Ann Vasc Surg. 2018; 51: 324.e7-324.e10
        • Cross J.E.
        • Galland R.B.
        Part One: for the Motion.
        Eur J Vasc Endovasc Surg. 2011; 41: 445-448
        • Dawson J.
        • Fitridge R.
        Update on aneurysm Disease: Current Insights and Controversies.
        Prog Cardiovasc Dis. 2013; 56: 26-35
        • Galiñanes E.L.
        • Dombrovskiy V.Y.
        • Graham A.M.
        • et al.
        Endovascular versus open repair of popliteal artery aneurysms: outcomes in the US Medicare population.
        Vasc Endovascular Surg. 2013; 47: 267-273
        • Björck M.
        • Beiles B.
        • Menyhei G.
        • et al.
        Editor’s Choice: Contemporary treatment of popliteal artery aneurysm in Eight countries: a report from the Vascunet collaboration of registries.
        Eur J Vasc Endovasc Surg. 2014; 47: 164-171
        • Mohan I.V.
        • Bray P.J.
        • Harris J.P.
        • et al.
        Endovascular popliteal aneurysm repair: are the results comparable to open Surgery?.
        Eur J Vasc Endovasc Surg. 2006; 32: 149-154
        • Barquera S.
        • Pedroza-Tobías A.
        • Medina C.
        • et al.
        Global Overview of the epidemiology of Atherosclerotic Cardiovascular Disease.
        Arch Med Res. 2015; 46: 328-338
        • Ministério da Saúde do Brasil
        Agência Nacional de Saúde Suplementar [Internet].
        ([cited 2021 Aug 30]. Available from:)
        • Universal Public Health System (SUS) of Brazil
        Autorizações de Internação Hospitalar aprovadas [Internet].
        (FIOCRUZ. [cited 2021 Jul 15]. Available from:)
        • Puech-Leão P.
        • Kauffman P.
        • Wolosker N.
        • et al.
        Endovascular grafting of a popliteal aneurysm using the saphenous vein.
        J Endovasc Surg Off J Int Soc Endovasc Surg. 1998; 5: 64-70
        • Johnson O.N.
        • Slidell M.B.
        • Macsata R.A.
        • et al.
        Outcomes of surgical management for popliteal artery aneurysms: an analysis of 583 cases.
        J Vasc Surg. 2008; 48: 845-851
        • Wooster M.
        • Back M.
        • Gaeto H.
        • et al.
        Late Longitudinal comparison of endovascular and open popliteal aneurysm repairs.
        Ann Vasc Surg. 2016; 30: 253-257
        • Garg K.
        • Rockman C.B.
        • Kim B.J.
        • et al.
        Outcome of endovascular repair of popliteal artery aneurysm using the Viabahn endoprosthesis.
        J Vasc Surg. 2012; 55: 1647-1653
        • Ravn H.
        • Bergqvist D.
        • Björck M.
        Nationwide study of the outcome of popliteal artery aneurysms treated surgically.
        Br J Surg. 2007; 94: 970-977
      1. vigitel_brasil_2019_vigilancia_fatores_risco.pdf [Internet].
        ([cited 2021 Jul 30]. Available from:)
        • Instituto Brasileiro de Geografia e Estatística
        (Painel de Indicadores | IBGE [Internet]. [cited 2021 Jul 16]. Available from:)
        • Morris-Stiff G.
        • Haynes M.
        • Ogunbiyi S.
        • et al.
        Is assessment of popliteal artery Diameter in patients undergoing screening for abdominal aortic aneurysms a Worthwhile procedure.
        Eur J Vasc Endovasc Surg. 2005; 30: 71-74
        • Trickett J.P.
        • Scott R.A.P.
        • Tilney H.S.
        Screening and management of asymptomatic popliteal aneurysms.
        J Med Screen. 2002; 9: 92-93
        • Lovegrove R.E.
        • Javid M.
        • Magee T.R.
        • et al.
        Endovascular and open Approaches to Non-thrombosed popliteal aneurysm repair: a meta-analysis.
        Eur J Vasc Endovasc Surg. 2008; 36: 96-100
        • Sousa R.S.
        • Oliveira-Pinto J.
        • Mansilha A.
        Endovascular versus open repair for popliteal aneurysm: a review on limb salvage and reintervention rates.
        Int Angiol [Internet]. 2020; ([cited 2021 Nov 4];39(5). Available from:)
        • Cervin A.
        • Acosta S.
        • Hultgren R.
        • et al.
        Results after open and endovascular repair of popliteal aneurysm: a matched comparison within a population based Cohort.
        Eur J Vasc Endovasc Surg. 2021; 61: 988-997
        • Corriere M.A.
        • Guzman R.J.
        True and False aneurysms of the femoral artery.
        Semin Vasc Surg. 2005; 18: 216-223
        • Diwan A.
        • Sarkar R.
        • Stanley J.C.
        • et al.
        Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms.
        J Vasc Surg. 2000; 31: 863-869