Ruptured Abdominal Aortic Aneurysm: A Retrospective Assessment of Open Versus Endovascular Repair

Vaddineni, Sarat K.; Russo, Gilberto C.; Patterson, Mark A.; Taylor, Steven M.; Jordan, William D.

doi:10.1007/s10016-005-7975-1

Cited by 52 publications

(24 citation statements)

References 17 publications

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“…This theory is supported by a Canadian study that, using predictive models, demonstrated improved RAAA mortality following the introduction of an endovascular program. 56 We have also reported several Greenberg et al 8 Hinchliffe et al 9 Veith and Ohki 10 Yilmaz et al 11 Van Herzeele et al 12 Scharrer-Palmer et al 13 Resch et al 14 Lee et al 15 May et al 16 Lombardi et al 17 Arya et al 18 Gerassimidis et al 19 Larzon et al 20 Brandt et al 21 Peppelenbosch et al 22 Alsac et al 23 Hechelhammer et al 24 Vaddineni et al 25 Castelli et al 26 Dalainas et al 27 Oranen et al 28 Greco et al 29 Visser et al 30 Hinchliffe et al 31 Acosta et al 32 Peppelenbosch et al 33 Coppi et al 34 Franks et al 35 Mehta et al 36 The reported mortality rates after endovascular repair vary a great deal in the literature. Useful data can be extracted from 2 registries 56,57 and 4 meta-analyses.…”

Section: Commentmentioning

confidence: 99%

Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Karkos

Harkin²,

Giannakou³

et al. 2009

Arch Surg

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Objective: To document mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs).Data Sources: MEDLINE and EMBASE databases.Study Selection: Articles that reported data on mortality after endovascular repair of RAAAs were identified. Only patients with true ruptures were included. Additionally, information on mortality after concurrent open repair was sought.Data Extraction: One of the authors reviewed all of the studies and extracted appropriate data. A total of 43 articles were identified, 14 of which were excluded.Data Synthesis: Twenty-nine articles with 897 patients who underwent endovascular repair met the inclusion criteria. Of the patients with available information, 86% were men; 29% had been operated on under local anesthesia; 28% were hemodynamically unstable; 17% required intra-aortic balloon occlusion; 48% received bifurcated stent grafts; 6% had endovascular procedures converted to open repair intraoperatively; and 5.5% developed abdominal compartment syndrome. Inhospital and/or 30-day mortality ranged between 0% and 54% in different series, whereas the pooled mortality after endovascular repair was 24.5% (95% confidence interval [CI], 19.8%-29.4%). In 19 studies reporting results of both endovascular and concurrent open repair from the same unit, the pooled mortality after open repair was 44.4% (95% CI, 40.0%-48.8%), and the pooled overall mortality for RAAA undergoing endovascular or open repair was 35% (95% CI, 30%-41%).Conclusions: Endovascular repair of RAAAs is associated with acceptable mortality rates. Additional studies will be required to verify these promising results and precisely define the role of endovascular treatment as an additional therapeutic option for RAAAs.

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Section: Commentmentioning

confidence: 99%

Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Karkos

Harkin²,

Giannakou³

et al. 2009

Arch Surg

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“…Few cases demonstrate the successful use of EVAR in hemodynamically unstable AAA. In cases like ours where patients represent high surgical mortality risk, EVAR may be a useful alternative [3][4][5][6][7][8][9][10][11][12][13]16,17,19,20]. We present our case as a piece of the growing evidence that EVAR may be useful in patients with a ruptured AAA that are also hemodynamically unstable.…”

Section: Discussionmentioning

confidence: 64%

“…Unfortunately, this information is derived from retrospective studies or case series with little randomized prospective data available, and the available studies may not adequately adjust for selection bias [4,[6][7][8][9][10]14,15]. There is a tendency for more severely unstable patients requiring a faster treatment decision to undergo traditional open repair, and because circulatory shock is a significant prognostic factor, this has been suggested to falsely improve the favorable EVAR results [1,2,4,[6][7][8][9][10][16][17][18]. However, in the available reported literature, patients who undergo EVAR for ruptured AAA tend to have greater co-morbidities and risk factors than those who are given open repair, and have a greater time delay to treatment due to CT scanning to confirm rupture [1,10,11,15,18].…”

Section: Discussionmentioning

confidence: 99%

Successful use of emergent endovascular aneurysm repair for a ruptured hypotensive abdominal aortic aneurysm

Basile¹,

Fiesseler²,

Shih³

2013

CRCM

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CASE REPORTA 66-year-old man presented to an emergency department with acute abdominal pain. The pain started abruptly and was severe in nature starting several hours before. Just prior to ED arrival, the patient had a brief syncopal episode lasting 1 -2 minutes. He complained of nausea but denied difficulty breathing, chest pain or recent illness. He had a past medical history significant for a myocardial infarction, hypercholesterolemia and hypertension. He denied smoking. His initial vital signs were temperature, 36.4˚C; heart rate, 101 beats per minute; respiratory rate, 18 per minute; and blood pressure, 97/56 mmHg. On physical examination, he appeared pale and in distress. His chest and cardiac examination were unremarkable. His abdomen was protuberant with marked diffuse tenderness and a pulsatile abdominal mass. A bedside ultrasound was immediately obtained that demonstrated a large AAA. Initial laboratory tests revealed a white blood cell count of 19.08 H/nL, hemoglobin of 13.3 g/dL, a creatinine of 1.3 mg/dL, and a troponin-I of 0.099 ng/mL. The remainder of the initial laboratory tests was unremarkable. Shortly after ED arrival the patient's systolic blood pressure decreased to 60 mmHg. With intravenous fluids the systolic blood pressure rose into the 70 -80 mmHg range. The patient remained awake and oriented with these blood pressures.The initial diagnosis was a hemodynamically unstable ruptured abdominal aortic aneurysm in need of acute surgical repair with a high mortality risk. The patient was considered for endovascular aneurysm repair and underwent an emergency CT scan of the abdomen and pelvis to assess eligibility for this procedure. Despite having a blood pressure that was in the 70 -80 mmHg range, the patient remained awake and alert. The patient was accompanied by the vascular surgery team to radiology while the CT scan was performed. The pre-radiology plan was if the patient decompensated during the performance of the CT scan, the vascular team would discontinue the CT scan and immediately take the patient for emergency open operative repair of the AAA.

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“…Reported results of reduced early mortality after EVAR for the treatment of a ruptured AAA compared to open surgery seems conclusive (table 1). However, the currently available, mainly observational, studies are small and add considerable heterogeneity and methodological limitations (Yilmaz et al, 2002;Reichart et al, 2003;Resch et al, 2003;Lee et al, 2004;Alsac et al, 2005;Brandt et al, 2005;Castelli et al, 2005;Hechelhammer et al, 2005;Kapma et al, 2005;Larzon et al, 2005;Vaddineni et al, 2005;Arya et al, 2006;Coppi et al, 2006;Franks et al, 2006;Hinchliffe et al, 2006;Peppelenbosch et al, 2006;Visser et al, 2006;Acosta et al, 2007;Ockert et al, 2007). Heterogeneity is signified by the broad range in percentages of patients treated with EVAR (15-50%) and in percentage of haemodynamical unstable patients (33-73% in the eEVAR group).…”

Section: Discussionmentioning

confidence: 99%

“…The above mentioned advantageous consequences of the minimally invasive endovascular approach of acute AAA might reflect on perioperative mortality. Approximately 26 studies comparing EVAR with conventional open surgery in patients with a ruptured AAA can be identified (Ohki & Veith 2000;van Sambeek et al, 2002;Verhoeven et al, 2002;Yilmaz et al, 2002;Reichart et al, 2003;Resch et al, 2003;Lee et al, 2004;Alsac et al, 2005;Brandt et al, 2005;Kapma et al, 2005;Larzon et al, 2005;Vaddineni et al, 2005;Arya et al, 2006;Coppi et al, 2006;Dalainas et al, 2006;Dillavou et al, 2006;Franks et al, 2006;Greco et al, 2006;Hinchliffe et al, 2006;Peppelenbosch et al, 2006;Visser et al, 2006;Acosta et al, 2007;Anain et al, 2007;Moore et al, 2007;Ockert et al, 2007;Egorova et al, 2008). Twenty-four of these studies compared early mortality of EVAR compared to open surgery (Ohki & Veith 2000;van Sambeek et al, 2002;Verhoeven et al, 2002;Yilmaz et al, 2002;Reichart et al, 2003;Resch et al, 2003;Lee et al, 2004;Alsac et al, 2005;Brandt et al, 2005;Kapma et al, 2005;Larzon et al, 2005;Vaddineni et al, 2005;…”

Section: Evar Versus Open Surgerymentioning

confidence: 99%