A Single-Institution Experience With Ruptured Aortic Aneurysms

Abstract

With the continued advancement in aortic endografts and increasing surgeon experience, endovascular aortic aneurysm repair (EVAR) is now commonly used for ruptured abdominal aortic aneurysms (rAAAs). Although randomized controlled trials have shown improved short-term morbidity and mortality with EVAR compared to open repair in the elective setting, the data for rAAA remain scarce. This study reviewed the data on rAAA at our institution and compared outcomes of open repair vs EVAR. All patients admitted to the University of Iowa Hospitals and Clinics between 2008 and 2015 with rAAA were identified. Demographic and clinical characteristics of patients were described using simple summary statistics. The distance from the hospital and the patients’ mode of transportation were also included. Categoric and continuous variables were analyzed using SPSS 22 software (IBM, Armonk, NY). There were 86 patients admitted to our institution with rAAA. Four were managed by palliative care, and 82 underwent surgical repair. The average distance to the local hospital at presentation was 12.5 miles, with 62.8% transported by ground and 37.2% airlifted, with an average distance of 57.7 miles. An equal number of patients (n = 41) underwent open repair and EVAR. Open femoral access was used in 47.5% of those who underwent EVAR, and 52.5% had percutaneous access. The overall mortality rate was 9.3% at 24 hours and 27.5% at 30 days. When mortality at 30 days was evaluated, there was no statistically significant difference between mode of transportation, distance from the patient’s home to the local hospital, or open repair vs EVAR. Among EVAR patients, there was no difference in 30-day mortality between type of femoral access or type of anesthesia. The primary factors associated with increased mortality were older age and increased number of medical comorbidities. In patients with rAAA, mortality appears to be more related to their age and the number of medical comorbidities rather than to the type of repair or the proximity to the hospital at the time of rupture.