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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.
MedLine Citation:
PMID:  21035700     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Dusadee Sarangarm; Jordan Knepper; John Marek; Kristen L Biggs; Diane Robertson; Mark Langsfeld
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  24     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1075-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA.
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