Background and Numbers

At least one person has asked if this surgery is in fact indicated for someone of Dad's age and condition. Beyond the assurances of the surgeon, I think so. Here's one article suggesting that it is:

Abdominal Aortic Aneurysm Repair Outcomes For Seniors Reviewed

Another thing that people tell you to do is determine the rates at which these surgerys are done at the hospital you're planning on using. I did not find these figures easy to come by. But here's what I found for New Jersey hospitals. By happenstance EVAR is one of the six or eight procedures that New Jersey has chosen to report on. Reassuring for me, but I have no idea what you would do if you were having something else done. But the data are for 2005, so while better than nothing, they're probably only marginally reflective of what's happening now.

In summary: At the hospital dad is going to, in 2005 they performed 19 of these procedures, meeting "threshold 1" for procedure frequency (10), but not threshold 2 (32). This is important because

One study that evaluated the impact of total vascular surgery volume found a significant effect for both ruptured and intact aneurysms.⁴⁰ Empirical evidence shows that AAA repair volume and mortality—after adjusting for age, sex, and APR-DRG—are independently and negatively correlated with each other (r=-.35, p<.001).⁴¹

40 Amundsen S, Skjaerven R, Trippestad A, et al. Abdominal aortic aneurysms. Is there an association between surgical volume, surgical experience, hospital type and operative mortality? Members of the Norwegian Abdominal Aortic Aneurysm Trial. Acta Chir Scand 1990;156(4):323-7; discussion 327-8

41 Nationwide Inpatient Sample.

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AHRQ Quality Indicators
Guide to Inpatient Quality Indicators:
Quality of Care in Hospitals – Volume, Mortality, and Utilization
http://www.qualityindicators.ahrq.gov/downloads/iqi/iqi_guide_v31.pdf

On the other hand, none of those 17 patients died, which is encouraging. The quality data is from "Inpatient Quality Indicators - New Jersey 2005" pages 10 and 14. http://www.state.nj.us/health/healthcarequality/documents/iqi2005.pdf

Finally, the question of whether to do the single stent and bypass to ensure blood flow to both iliac arteries, or to do a bifurcated stent and supply both arteries directly. Total absent of the particulars of the case, the following article seems to indicate that the bifurcated stent is slightly preferable:

We do not know the long-term patency of a femoral artery to a femoral artery bypass graft. By placing the AUI stent, the blood supply to both limbs are at risk if the iliac portion of the device has a mechanical complication.

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The Use of the Aorto-Uni-Iliac Device in the Treatment of Abdominal Aortic Aneurysms
VOLUME: 5 PUBLICATION DATE: Nov 01 2008
Issue Number: 6 Nov/Dec 08
http://vasculardiseasemanagement.com/content/the-use-aorto-uni-iliac-device-treatment-abdominal-aortic-aneurysms

Overall, I've found the process of getting good data to be rather frustrating, and I'm very skeptical of all the people who say that if you don't do a complete statistical run-down on your prospective hospital and surgeon you're not doing due diligence. The data either aren't out there or are very hard to find. I would have expected good data from the government, who claims to have an interest in limiting health care costs and improving outcomes. And indeed the best data I've found has been from the government, but it's pretty outdated.

All in all, this is not an issue for us because A) the hospital where Dad is getting his procedure done (and the surgeon, to the best of our knowledge) are pretty good, and B) He's decided that he doesn't want to shop around anyway.

So this is about as much due diligence as I've done.