Advantages of implementing a hybrid operating room for endovascular aortic aneurysm repair at a new vascular surgery centre.

Background: Endovascular aortic aneurysm repair (EVAR) has evolved into a widely established alternative to traditional open surgical repair. For EVAR procedures, both mobile (standard operating room (SOR)) and fixed C-arm (hybrid operating room (HOR) systems are available. The aim of our study was to evaluate the advantages of implementing a HOR for endovascular aortic aneurysm repair at a new vascular surgery centre. Materials and methods: Between April 2020 and December 2024, data of 140 patients who treated endovascularly for aortic aneurysms (AAs) were retrospectively evaluated. In detail, between April 2020 and March 2023, in 43 consecutive cases a mobile C-arm device was used, compared to the second period from April 2023 up to December 2024 when 97 consecutive patients with AAs were treated in a HOR. Primary endpoints of the study were procedural duration, radiation exposure time, and radiation dose. Results: Radiation exposure was significantly lower in the HOR group, with median radiation time of 15.3 vs. 23.1 minutes and median dose of 7.9 vs. 13.5 Gy·cm² (p<.001). The EVAR radiation time (14.1 vs. 20.6 minutes) and dose (6.6 vs. 11.4 Gy·cm²) remained significantly lower in the HOR group (p<.001). The implementation of the HOR was associated with a 125% increase of treated cases, resulting in a nearly four-fold rise of the total monthly case volume compared to the first period with the mobile C-arm. Discussion: The results of our study highlight the advantages of the HOR, such as reduced radiation, improved workflow efficiency and greater procedural capacity. Conclusions: Newly founded vascular centres should consider incorporating a HOR at the earliest opportunity.