Abstract
Objectives: An increasing number of patients are receiving endovascular abdominal aortic aneurysm repair (EVAR) in an off-label situation. In light of the increasing complexity of EVAR cases, it is important to assess the impact of training residents on patient outcomes. Methods: Between May 2008 and August 2009, a total of 66 consecutive patients underwent EVAR, of which 33 patients received EVAR performed by a resident surgeon (RS). The surgical outcomes in the RS group were compared with those of the remaining 33 patients operated on by an attending surgeon (AS). The RS group included 15 patients with unsuitable anatomy defined in the instructions for use (IFU) of endografts, while the AS group had 14 non-IFU patients. Results: Patients in the RS group were significantly more likely to have a history of previous laparotomy. Regarding other baseline characteristics, there were no differences between the two groups. Endovascular stent-graft deployment was successful in all patients. Operative time was longer in the AS group (151±45 minutes vs. 127±32 minutes) but the difference was not statistically significant. Blood loss was also higher in the AS group (339±219 mL vs. 232±151 mL) but was also not statistically significant. Postoperative complications occurred in 6 patients in the AS group and 3 patients in the RS group (p=0.028). Early endoleak (within 1 week) was observed significantly more frequently in the AS group (n=11) than in the RS group (n=4) (p<0.05). However, this significant difference disappeared one month after EVAR because of complete resolution of endoleaks. Conclusion: Supervised RS can safely perform EVAR with reasonable early results even in the era of off-label indications.
