ASG Score Clinically Valid for Endovascular Aneurysm Repair

NAPLES, FLA. – The Anatomic Severity Grade score is a clinically valid indicator of which patients about to undergo endovascular aneurysm repair are more likely to present technical challenges, such as a need for additional endovascular implants or adjunct maneuvers, according to a retrospective study.

Increased operating time, length of hospital stay, blood loss, use of contrast, number of adjunct maneuvers, and costs were each significantly higher among 52 patients with a higher Anatomic Severity Grade (ASG) score, compared with 58 others who scored lower.

Dr. Sadaf S. Ahanchi of Eastern Virginia Medical School, Norfolk, and her colleagues reviewed patient factors, early outcomes, and costs for all patients who underwent endovascular intervention at the medical school for an infrarenal abdominal aortic aneurysm between April 2009 and July 2010. Their aim was to assess how the ASG score translated clinically regarding endovascular aneurysm repair in this patient population.

In 2002, the Society for Vascular Surgery and the American Association for Vascular Surgery devised the scoring system to grade abdominal aortic aneurysms. The ASG score would be 0 in a patient with optimal anatomy and would range up to 44 in a patient with complex anatomy, Dr. Ahanchi said. In the current study, patients were classified into a low-score group (defined as an ASG score of less than 14 points) and a high-score group (a score of 14 points or higher). Each patient’s total ASG score was calculated preoperatively based on aortic neck, aneurysm, and iliac anatomic factors, such as diameter, length, angulation, and tortuosity, using three-dimensional imaging software from M2S Inc. in West Lebanon, N.H.

The ASG score "can be easily and rapidly calculated from CT images using 3-D imaging," Dr. Ahanchi said.

Mean procedure time was longer in the high-score group, at 210 minutes vs. 113 minutes in the low-score group. The amount of contrast used was greater (at 131 mL vs. 100 mL), and blood loss was greater in the high-score group, at 886 mL vs. 227 mL in the low-score group.

Half of the high-score patients required access adjunct maneuvers, compared with only 14% of the low-score patients. Endarterectomy, patch angioplasty, and percutaneous angioplasty were the most common access-site adjuncts. Intraoperative adjuncts were required by 80% of the high-score group vs. 54% of the others; these included distal limb extension, access-site management, and iliac artery occlusive disease management.

Total mean number of endograft implants used during the cases was four in the high-score group vs. three in the low-score group, a statistically significant difference.

No patient was converted to an open repair. Length of stay was an average 5 days in the high-score group vs. 2 days in the lower-score patients, Dr. Ahanchi said.

No patient died within the first 30 days. At a mean follow-up of 5 months, there were no endograft issues or aneurysm-related deaths. Two patients in the high-score group died of unrelated causes, Dr. Ahanchi said.

Total systemic morbidity – 35% in the high score group vs. 18% in the low score group – "trended toward significant and were mostly respiratory and wound complications."

The patients with high ASG scores accounted for a 55% increase in operating room supply costs and a 48% increase in hospital charges, compared with the low-scoring patients. Mean OR supply charges were $25,765 in the high-score group vs. $16,646 in the low-score group. Total mean hospital charges were $105,153 among the high-score patients vs. $70,956 for the low-score group.

More than 90% of patients in the study had an aneurysm greater than 5 cm. Mean patient age was 75 years, 78% were men, and 91% were asymptomatic. A majority (81%) was white, 17% were black, and 2% were "other." All patients were retrospectively identified using CPT codes. To limit confounding variables, the researchers included only patients who had a Talent or AneuRx brand endograft (Medtronic).

Dr. Ahanchi said she had no relevant disclosures.

NAPLES, FLA. – The Anatomic Severity Grade score is a clinically valid indicator of which patients about to undergo endovascular aneurysm repair are more likely to present technical challenges, such as a need for additional endovascular implants or adjunct maneuvers, according to a retrospective study.

Increased operating time, length of hospital stay, blood loss, use of contrast, number of adjunct maneuvers, and costs were each significantly higher among 52 patients with a higher Anatomic Severity Grade (ASG) score, compared with 58 others who scored lower.

Dr. Sadaf S. Ahanchi of Eastern Virginia Medical School, Norfolk, and her colleagues reviewed patient factors, early outcomes, and costs for all patients who underwent endovascular intervention at the medical school for an infrarenal abdominal aortic aneurysm between April 2009 and July 2010. Their aim was to assess how the ASG score translated clinically regarding endovascular aneurysm repair in this patient population.

In 2002, the Society for Vascular Surgery and the American Association for Vascular Surgery devised the scoring system to grade abdominal aortic aneurysms. The ASG score would be 0 in a patient with optimal anatomy and would range up to 44 in a patient with complex anatomy, Dr. Ahanchi said. In the current study, patients were classified into a low-score group (defined as an ASG score of less than 14 points) and a high-score group (a score of 14 points or higher). Each patient’s total ASG score was calculated preoperatively based on aortic neck, aneurysm, and iliac anatomic factors, such as diameter, length, angulation, and tortuosity, using three-dimensional imaging software from M2S Inc. in West Lebanon, N.H.

The ASG score "can be easily and rapidly calculated from CT images using 3-D imaging," Dr. Ahanchi said.

Mean procedure time was longer in the high-score group, at 210 minutes vs. 113 minutes in the low-score group. The amount of contrast used was greater (at 131 mL vs. 100 mL), and blood loss was greater in the high-score group, at 886 mL vs. 227 mL in the low-score group.

Half of the high-score patients required access adjunct maneuvers, compared with only 14% of the low-score patients. Endarterectomy, patch angioplasty, and percutaneous angioplasty were the most common access-site adjuncts. Intraoperative adjuncts were required by 80% of the high-score group vs. 54% of the others; these included distal limb extension, access-site management, and iliac artery occlusive disease management.

Total mean number of endograft implants used during the cases was four in the high-score group vs. three in the low-score group, a statistically significant difference.

No patient was converted to an open repair. Length of stay was an average 5 days in the high-score group vs. 2 days in the lower-score patients, Dr. Ahanchi said.

No patient died within the first 30 days. At a mean follow-up of 5 months, there were no endograft issues or aneurysm-related deaths. Two patients in the high-score group died of unrelated causes, Dr. Ahanchi said.

Total systemic morbidity – 35% in the high score group vs. 18% in the low score group – "trended toward significant and were mostly respiratory and wound complications."

The patients with high ASG scores accounted for a 55% increase in operating room supply costs and a 48% increase in hospital charges, compared with the low-scoring patients. Mean OR supply charges were $25,765 in the high-score group vs. $16,646 in the low-score group. Total mean hospital charges were $105,153 among the high-score patients vs. $70,956 for the low-score group.

More than 90% of patients in the study had an aneurysm greater than 5 cm. Mean patient age was 75 years, 78% were men, and 91% were asymptomatic. A majority (81%) was white, 17% were black, and 2% were "other." All patients were retrospectively identified using CPT codes. To limit confounding variables, the researchers included only patients who had a Talent or AneuRx brand endograft (Medtronic).

Dr. Ahanchi said she had no relevant disclosures.

NAPLES, FLA. – The Anatomic Severity Grade score is a clinically valid indicator of which patients about to undergo endovascular aneurysm repair are more likely to present technical challenges, such as a need for additional endovascular implants or adjunct maneuvers, according to a retrospective study.

Increased operating time, length of hospital stay, blood loss, use of contrast, number of adjunct maneuvers, and costs were each significantly higher among 52 patients with a higher Anatomic Severity Grade (ASG) score, compared with 58 others who scored lower.

Dr. Sadaf S. Ahanchi of Eastern Virginia Medical School, Norfolk, and her colleagues reviewed patient factors, early outcomes, and costs for all patients who underwent endovascular intervention at the medical school for an infrarenal abdominal aortic aneurysm between April 2009 and July 2010. Their aim was to assess how the ASG score translated clinically regarding endovascular aneurysm repair in this patient population.

In 2002, the Society for Vascular Surgery and the American Association for Vascular Surgery devised the scoring system to grade abdominal aortic aneurysms. The ASG score would be 0 in a patient with optimal anatomy and would range up to 44 in a patient with complex anatomy, Dr. Ahanchi said. In the current study, patients were classified into a low-score group (defined as an ASG score of less than 14 points) and a high-score group (a score of 14 points or higher). Each patient’s total ASG score was calculated preoperatively based on aortic neck, aneurysm, and iliac anatomic factors, such as diameter, length, angulation, and tortuosity, using three-dimensional imaging software from M2S Inc. in West Lebanon, N.H.

The ASG score "can be easily and rapidly calculated from CT images using 3-D imaging," Dr. Ahanchi said.

Mean procedure time was longer in the high-score group, at 210 minutes vs. 113 minutes in the low-score group. The amount of contrast used was greater (at 131 mL vs. 100 mL), and blood loss was greater in the high-score group, at 886 mL vs. 227 mL in the low-score group.

Half of the high-score patients required access adjunct maneuvers, compared with only 14% of the low-score patients. Endarterectomy, patch angioplasty, and percutaneous angioplasty were the most common access-site adjuncts. Intraoperative adjuncts were required by 80% of the high-score group vs. 54% of the others; these included distal limb extension, access-site management, and iliac artery occlusive disease management.

Total mean number of endograft implants used during the cases was four in the high-score group vs. three in the low-score group, a statistically significant difference.

No patient was converted to an open repair. Length of stay was an average 5 days in the high-score group vs. 2 days in the lower-score patients, Dr. Ahanchi said.

No patient died within the first 30 days. At a mean follow-up of 5 months, there were no endograft issues or aneurysm-related deaths. Two patients in the high-score group died of unrelated causes, Dr. Ahanchi said.

Total systemic morbidity – 35% in the high score group vs. 18% in the low score group – "trended toward significant and were mostly respiratory and wound complications."

The patients with high ASG scores accounted for a 55% increase in operating room supply costs and a 48% increase in hospital charges, compared with the low-scoring patients. Mean OR supply charges were $25,765 in the high-score group vs. $16,646 in the low-score group. Total mean hospital charges were $105,153 among the high-score patients vs. $70,956 for the low-score group.

More than 90% of patients in the study had an aneurysm greater than 5 cm. Mean patient age was 75 years, 78% were men, and 91% were asymptomatic. A majority (81%) was white, 17% were black, and 2% were "other." All patients were retrospectively identified using CPT codes. To limit confounding variables, the researchers included only patients who had a Talent or AneuRx brand endograft (Medtronic).

Dr. Ahanchi said she had no relevant disclosures.