Appropriateness of surgery performed for abdominal aortic aneurysm at tertiary hospitals in Spain

Int Angiol . 2021 Aug;40(4):289-296. doi: 10.23736/S0392-9590.21.04654-X. Epub 2021 Jun 1.

Fecha de la publicación: 01/06/2021

Autor: Xavier Bonfill (1, 2, 3), M Jesús Quintana (4, 5, 6), José R Escudero (6, 7, 8), Manuel Miralles (9), Joan Fité (7), Ederi Mikelarena (10), Borja Castejón (11), Marta Garnica (11), Inés Fernández DE Valderrama (12), Ana Rodriguez-Montalban (12), José I Pijoan (5, 13), Sergi Bellmunt-Montoya (6, 8, 14), AAA Spanish study group




1Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain –

2CIBER for Epidemiology and Public Health (CIBERESP), Madrid, Spain –

3Autonomous University of Barcelona, Barcelona, Spain –

4Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau (IIB Sant Pau), Barcelona, Spain.

5CIBER for Epidemiology and Public Health (CIBERESP), Madrid, Spain.

6Autonomous University of Barcelona, Barcelona, Spain.

7Joint Service of Angiology, Vascular and Endovascular Surgery, University Hospital de la Santa Creu i Sant Pau-Hospital Dos de Maig, Barcelona, Spain.

8CIBER for Cardiovascular Diseases (CIBERCV), Madrid, Spain.

9Department of Surgery, University of Valencia, Valencia, Spain.

10Donostia University Hospital, San Sebastián, Spain.

11Ruber International Hospital, Madrid, Spain.

12.12 de Octubre University Hospital, Madrid, Spain.

13Clinical Epidemiology Unit, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain.

14Department of Angiology, Vascular and Endovascular Surgery, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron University Hospital, Barcelona, Spain.


Background: The aim of this study was to analyze the appropriateness of the type of repair (open or endovascular) performed for abdominal aortic aneurysm (AAA) in five university hospitals in Spain, according to evidence-based recommendations.

Methods: A multicenter, retrospective cross-sectional study of patients with AAA who underwent elective open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Data were collected on demographic and clinical variables and type of surgical repair. A pair of vascular surgeons from each participating hospital performed a blinded assessment based on GRADE recommendations. The concordance between the two evaluators and the agreement between their evidence-based recommendation and the procedure performed were assessed.

Results: A total of 186 patients were selected; 179 were included. Mean age was 72.5 years (standard deviation [SD], 8.4), mean Charlson Comorbidity Index (CCI) was 2.04 (SD, 1.9). OSR was performed in 53.2% (N.=99) and EVAR in 46.8% (N.=87) of cases. Overall, 65.9% (118/179) of interventions performed were considered appropriate: 50% (47/94) of OSRs and 83.5% (71/85) of EVARs. The patient characteristics were similar for all the hospitals, but the chosen surgical technique did show significant differences among these centers. There were no significant differences among the hospitals in the proportion of cases judged as appropriate, either overall (P=0.346) or for each type of procedure (P=0.531 and P=0.538 for OSR and EVAR, respectively).

Conclusions: In this study, most of the AAA repairs performed were appropriate according to GRADE recommendations. A higher proportion of EVARs were considered appropriate than OSRs. Choice of AAA repair should be standardized using evidence-based clinical practice guidelines, while incorporating patient preferences, to reduce the existing variability and ensure appropriate selection of AAA repair technique.