Long-term outcome of ruptured abdominal aortic aneurysm: impact of treatment and age

Abstract

BackgroundDespite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR), conventional open repair (OPEN), and conservative treatment in elderly patients with rAAA.MethodsWe conducted a retrospective study of all rAAA patients treated with OPEN or eEVAR between January 2005 and December 2011 in the vascular surgery department at Amphia Hospital, the Netherlands. The outcome in patients treated for rAAA by eEVAR or OPEN repair was investigated. Special attention was paid to patients who were admitted and did not receive operative intervention due to serious comorbidity, extremely advanced age, or poor physical condition. We calculated the 30-day rAAA-related mortality for all rAAA patients admitted to our hospital.ResultsTwelve patients did not receive operative emergency repair due to extreme fragility (mean age 87 years, median time to mortality 27 hours). Twenty-three patients had eEVAR and 82 had OPEN surgery. The 30-day mortality rate in operated patients was 30% (7/23) in the eEVAR group versus 26% (21/82) in the OPEN group (P=0.64). No difference in mortality was noted between eEVAR and OPEN over 5 years of follow-up. There were more cardiac adverse events in the OPEN group (n=25, 31%) than in the eEVAR group (n=2, 9%; P=0.035). Reintervention after discharge was more frequent in patients who received eEVAR (35%) than in patients who had OPEN (6%, P<0.001). Advancing age was associated with increasing mortality (hazard ratio 1.05 [95% confidence interval 1.01–1.09]) per year for patients who received operative repair, with a 67%, 76%, and 100% 5-year mortality rate in the 34 patients aged <70 years, 59 patients aged 70–79 years, and 12 octogenarians, respectively; 30-day rAAA-related mortality was also associated with increasing age (21%, 30%, and 61%, respectively; P=0.008).ConclusionThe 30-day and 5-year mortality in patients who survived rAAA was equal between the treatment options of eEVAR and OPEN. Particularly fragile and very elderly patients did not receive operative repair. The decision to intervene in rAAA should not be made on the basis of patient age alone, but also in relation to comorbidity and patient preference.

Endovascular Aneurysm Repair or Open Aneurysm Repair for the Treatment of Abdominal Aortic Aneurysm – The Latest Update

“…The studies conducted in Europe did not reveal significant difference between EVAR and OAR used for the treatment of ruptured AAA in the shortterm outcomes (31,33,35). Moreover, for the patients undergoing elective operations of AAA and emergency procedure for the ruptured AAA relatively low rate of perioperative mortality and well long-term survival were reported for both methods of treatment (31,33,35,42,43,45). In view of technical difficulties in videoscopic approach with a long learning curve and high cost of robotic system, EVAR or OAR remain routine methods used for AAA repair in the world.…”

“…Re-intervention after discharge was more frequent in the patients following EVAR 35% than after OAR 6% (p < 0.001). Advanced age of the patients was associated with significantly increased mortality in the OAR group (35).…”

Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital

“…Immediate diagnosis and rapid treatment are critical. Despite advances in surgery and endovascular repair, the mortality rate for rAAA surgery is as high as 30-50% (4,5). Emergency EVAR is an alternative in patients with rAAA (5).…”

“…Despite advances in surgery and endovascular repair, the mortality rate for rAAA surgery is as high as 30-50% (4,5). Emergency EVAR is an alternative in patients with rAAA (5). The minimally invasive nature of this technique allows aneurysm repair in patients with a rAAA who would be at significant risk for open surgery (5).…”

“…Emergency EVAR is an alternative in patients with rAAA (5). The minimally invasive nature of this technique allows aneurysm repair in patients with a rAAA who would be at significant risk for open surgery (5).…”