Endovascular versus open repair of ruptured abdominal aortic aneurysm

McHugh, SM; Aherne, Thomas; Goetz, Thomas J.; Byrne, John; Boyle, E.; Allen, Michael; Leahy, A.; Moneley, D.; Naughton, Peter

doi:10.1016/j.surge.2015.05.004

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…3,23 Although it is tempting to attribute the favorable mortality trends in the current study to the use of endovascular repair, numerous nonrandomized studies have demonstrated equivalent short-term mortality between open and endovascular repair. 7,11,14,[24][25][26] Additionally, 3 randomized clinically controlled trials have shown no short-term mortality benefit with endovascular repair for rAAA. 12,16,27 A meta-analysis of these trials also failed to show a mortality benefit of endovascular repair compared with open.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Retrospective reviews comparing the 2 modalities reveal that outcomes with endovascular repair are similar, and possibly superior, to open repair. [4][5][6][7][8][9][10][11] Data indicate long-term survival after endovascular repair is comparable to open repair; however, prospective and randomized controlled trials suggest endovascular repair may improve 30-day mortality. [12][13][14][15][16] Other data evaluating the effect of an endovascular-first protocol for the treatment of qualified patients with rAAA demonstrate reductions in postoperative mortality and complications.…”

Section: Introductionmentioning

confidence: 99%

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Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair

Wessels

Calvo

Sise

et al. 2020

Vasc Endovascular Surg

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Objective: Open repair of ruptured abdominal aortic aneurysm (rAAA) has shown improved outcomes at trauma centers. Whether the benefit of trauma center designation extends to endovascular repair of rAAA is unknown. Methods: Retrospective cohort study using the California Office of Statewide Health Planning and Development 2007 to 2014 discharge database to identify patients with rAAA. Data included demographic and admission factors, discharge disposition, International Classification of Diseases, Ninth Revision, Clinical Modification codes, and hospital characteristics. Hospitals were categorized by trauma center designation and teaching hospital status. The effect of repair type and trauma center designation (level I, level II, or other—other trauma centers and nondesignated hospitals) was evaluated to determine rates and risks of 9 postoperative complications, in-hospital mortality, and 30-day postdischarge mortality. Results: Of 1941 rAAA repair patients, 61.2% had open and 37.8% had endovascular; 1.0% had both. Endovascular repair increased over the study interval. Hospitals were 12.0% level I, 25.0% level II, and 63.0% other. A total of 48.7% of hospitals were teaching hospitals (level I, 100%; level II, 42.2%; and other, 41.8%). Endovascular repair was significantly more common at teaching hospitals (41.5% vs 34.3%, P < .001) and was the primary repair method at level I trauma centers ( P < .001). Compared with open repair, endovascular repair was protective for most complications and in-hospital mortality. The risk for in-hospital mortality was highest among endovascular patients at level II trauma centers (hazard ratio 1.67, 95% confidence interval [CI]: 0.95-2.92) and other hospitals (hazard ratio 1.66, 95% CI: 1.01-2.72). Conclusions: Endovascular repair overall was associated with a lower risk of adverse outcomes. Endovascular repair at level I trauma centers had a lower risk of in-hospital mortality which may be a result of their teaching hospital status, organizational structure, and other factors. The weight of the contributions of such factors warrants further study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair

Wessels

Calvo

Sise

et al. 2020

Vasc Endovascular Surg

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“…The majority (n = 12, 80%) was males. We were also able to compare to the previous published incident of RAAA surgery rate in our institution, with a paper by the authors noted 54 RAAA surgeries over 58 months (9.3 RAAA/annum) [1].…”

Section: Dear Editormentioning

confidence: 94%

Rates of ruptured abdominal aortic aneurysm during the COVID-19 pandemic in Ireland: letter to the editor

et al. 2022

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“…Today, patients presenting with a rAAA are most often treated with open repair (OR) [ 1 ]. Endovascular aneurysm repair (EVAR) is less invasive compared to OR and is widely accepted as a method with clear benefits to patients undergoing elective AAA repair [ 4 ]. A debate exists regarding the definitive benefit in EVAR for rAAA patients [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Endovascular vs. Open Repair for Ruptured Abdominal Aortic Aneurysm

Patelis

Moris

Karaolanis

et al. 2016

Med Sci Monit Basic Res

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BackgroundPatients presenting with ruptured abdominal aortic aneurysms are most often treated with open repair despite the fact that endovascular aneurysm repair is a less invasive and widely accepted method with clear benefits for elective aortic aneurysm patients. A debate exists regarding the definitive benefit in endovascular repair for patients with a ruptured abdominal aortic aneurysm. The aim of this literature review was to determine if any trends exist in favor of either open or endovascular repair.Material/MethodsA literature search was performed using PUBMED, OVID, and Google Scholar databases. The search yielded 64 publications.ResultsOut of 64 publications, 25 were retrospective studies, 12 were population-based, 21 were prospective, 5 were the results of RCTs, and 1 was a case-series. Sixty-one studies reported on early mortality and provided data comparing endovascular repair (rEVAR) and open repair (rOR) for ruptured abdominal aneurysm groups. Twenty-nine of these studies reported that rEVAR has a lower early mortality rate. Late mortality after rEVAR compared to that of rOR was reported in 21 studies for a period of 3 to 60 months. Results of 61.9% of the studies found no difference in late mortality rates between these 2 groups. Thirty-nine publications reported on the incidence of complications. Approximately half of these publications support that the rEVAR group has a lower complication rate and the other half found no difference between the groups. Length of hospital stay has been reported to be shorter for rEVAR in most studies. Blood loss and need for transfusion of either red cells or fresh frozen plasma was consistently lower in the rEVAR group.ConclusionsDifferences between the included publications affect the outcomes. Randomized control trials have not been able to provide clear conclusions. rEVAR can now be considered a safe method of treating rAAA, and is at least equal to the well-established rOR method.

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Endovascular versus open repair of ruptured abdominal aortic aneurysm

Cited by 9 publications

References 15 publications

Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair

Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair

Rates of ruptured abdominal aortic aneurysm during the COVID-19 pandemic in Ireland: letter to the editor

Endovascular vs. Open Repair for Ruptured Abdominal Aortic Aneurysm

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