Endovascular vs open repair for ruptured abdominal aortic aneurysm

Abstract

Objective Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). Methods Records were retrospectively reviewed from May 2000 to September 2010 for repair of infrarenal rAAAs. Primary end points included perioperative mortality and midterm survival. Secondary end points included acute limb ischemia, length of stay, ventilator-dependent respiratory failure, myocardial infarction, renal failure, abdominal compartment syndrome, and secondary intervention. Statistical analysis was performed using the t-test,X2 test, the Fisher exact test, and logistic regression calculations. Midterm survival was assessed with Kaplan-Meier analysis and Cox proportional hazard models. Results Seventy-four infrarenal rAAAs were repaired, 19 by EVAR and 55 by OSR. Despite increased age and comorbidity in the EVAR patients, perioperative mortality was 15.7% for EVAR, which was significantly lower than the 49% for OSR (odds ratio, 0.19; 95% CI, 0.05-0.74; P = .008). Midterm survival also favored EVAR (hazard ratio, 0.40; 95% CI, 0.21-0.77; P = .028, adjusted for age and sex). Mean follow-up was 20 months, and 1-year survival was 60% for EVAR vs 45% for OSR. Mean length of stay for patients surviving >1 day was 10 days for EVAR and 21 days for OSR (P = .004). Ventilator-dependent respiratory failure was 5% in the EVAR group vs 42% for OSR (odds ratio, 0.08; 95% CI, 0.01-0.62; P = .001). Conclusions EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care.

Effects of weekend admission on the outcomes and management of ruptured aortic aneurysms

“…EVAR and open surgical aneurysm repair are the predominant surgical methods used in the acute setting for a ruptured aortic aneurysm, with EVAR currently being preferred due to some studies suggesting a lower perioperative morbidity and mortality, although as stated previously some studies also refute this 21, 22 . We found that patients admitted on the weekdays and weekends for ruptured AAA had similar rates of EVAR and open repair while the difference was significant in TAA.…”

Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm

“…11,12 EVAR is characterized by slight trauma, which avoids great pain and anguish brought by traditional surgery, reduces the incidence of complications and mortality of patient heart, lungs, and other vital organs, especially provides treatment opportunities for patients who are with serious complications and cannot be expected to tolerate traditional OSR. 13,14 OSR has long been a standard treatment for ruptured AAA. 15 It is usually performed under general anesthesia to take abdominal incision, layer by layer separation of soft tissue to show AAA proximal and distal aneurysm neck and expose AAA.…”

Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms: Is Now EVAR the First Choice of Treatment?

“…Since the first published report of EVAR for rAAA (rEVAR) in 1994 [10], several studies have demonstrated its feasibility and a strong correlation between rEVAR and improved 30-day mortality outcomes compared with OR [11,12]. Although several case series have demonstrated reduction in mortality and morbidity with rEVAR compared with OR, most of the data are few, retrospectively evaluated, and limited by bias in the selection of patients [13].…”