Endovascular vs. Open Repair for Ruptured Abdominal Aortic Aneurysm

Abstract

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.

Ruptured abdominal aortic aneurysm: open vs. endovascular repair: literature review

“…The consensus relating to long-term mortality is equally unclear, with significant heterogeneity between studies [46]. Time intervals in the reporting of late mortality are variable, ranging from three months to over seven years [46,47].…”

“…Time intervals in the reporting of late mortality are variable, ranging from three months to over seven years [46,47]. The majority of observational studies report that there are no late mortality benefits using an endovascular approach [36].…”

“…However, this is circumvented by the fact that by seven years, there is no clear difference in mortality between the two approaches (hazard ratio: 0.86, 0.68-1.08) [47]. Interestingly, there is a growing body of observational research reporting that EVAR is associated with a statistically significant lower late mortality incidence compared to OR [40,46], however, this has yet to be demonstrated in randomised trials, and thus needs to be scientifically validated. Mirroring the short-term mortality conclusions, no randomised trial suggests that EVAR confers any long-term mortality advantages when compared to OR.…”

“…The majority of observational studies report complication incidence in a narrative, with the remaining studies reporting statistical significance split between no difference and EVAR superiority [46]. The Cochrane systematic review and meta-analysis by Badger et al involving two of the major RCTs and the one pilot trial reports on 30-day complication incidence rates between EVAR and OR for rAAA [15].…”

Introductory Chapter: Limits of Aortic Aneurysm

“…tions, but this approach is useful in patients who require creation of deinitive landing zone [20]. Another frequent choice of endovascular repair is ruptured AAAs due to easier and more noninvasive nature of the procedure, whereas open surgical treatment has similar or beter outcomes [21].…”