Hybrid operating room transition in abdominal aortic aneurysm treatment: Impacts on operative outcomes and complications

<h2>Abstract</h2><h3>Objective</h3> The aim of this study was to explore whether performing endovascular aortic repair (EVAR) in a hybrid room (HR) has a benefit on radiation exposure, volume of contrast, postoperative renal insufficiency, and complication rate (endoleak, thrombosis, reoperation) in the long term compared with conventional rooms (CRs). A literature review was previously carried out to define the impact of this hybrid technology on interventional performance. <h3>Methods</h3> This retrospective study compared consecutive patients undergoing standard elective EVAR at Centre Hospitalier Universitaire de Quebec from December 2015 and September 2022, while transitionning to a hybrid endovascular room. Patients were divided into two groups: the CR group included EVARs performed in a conventional operating room with a mobile C-arm (December 2015 to November 2019), and the HR group included EVARs performed in a hybrid room using a fixed angiographic system (December 2019 to September 2022). Data analysed included radiation exposure (mGy) and contrast volume, fluoroscopy time, acute renal failure, endoleaks, limb thrombosis, and reintervention. <h3>Results</h3> A total of 314 patients were included (202 in the HR group and 112 in the CR group). Groups were comparable in demographic characteristics and comorbidities. Radiation exposure was significantly higher in the HR group (679.5 mGy) compared with the CR group (244.5 mGy) (<i>P</i> < .001) without significant change in fluoroscopy time (<i>P</i> = .103). Contrast volume was equivalent between groups. However, the CR group presented with a higher rate of renal failure (5.4% vs 1%). Adjuvant procedures at the time of EVAR implantation were more frequent in the HR group. Their overall late reintervention rate did not differ significantly. <h3>Conclusions</h3> EVAR procedures performed in the hybrid suite at our center showed increased radiation exposure, partly attributable to more adjuvant procedures. It did not, however, have a significant impact on late outcomes.