Endovascular and Open Repair of Ruptured Infrarenal Aortic Aneurysms at a Tertiary Care Center

Abstract

The mortality of ruptured abdominal aortic aneurysms (rAAAs) has been reported as high as 90%. Loss of consciousness and a systolic blood pressure of <80mm Hg on presentation are the most important predictors of mortality after emergent open repair (OR). Endovascular repair of abdominal aortic aneurysm (EVAR) has reduced short-term operative mortality and morbidity for elective abdominal aortic aneurysm repair, and may be advocated for wider application of EVAR for rAAA. The objective of this study is to compare our experience with OR and EVAR management of rAAA. Retrospective review of all rAAAs presenting to a tertiary care center between January 1, 2000 and December 31, 2011 was performed. Patients were grouped based on the surgical approach (OR versus EVAR). Patient demographics, intraoperative details, and postoperative mortality and morbidity rates were compared. Statistical analyses were conducted with Stata, version12. One hundred twenty-six patients presented with rAAA over the study period. Patients who declined repair (n=14) or died before repair (n=13) were excluded from this study. Of the 99 patients who underwent repair, 25 patients (25.3%) received EVAR and 74 (74.7%) underwent OR. One patient required conversion to OR from EVAR (1.0%). Overall, 30-day and 1-year mortality was 35.4% and 41.4%, respectively, with no difference seen between the 2 types of repair (30-day mortality: EVAR=24.0%, OR=39.2%, P=0.17; 1-year mortality: EVAR=32.0%, OR=44.6%, P=0.27). Major morbidity also did not differ between the 2 repair procedures (EVAR=60.0%, OR=60.8%, P=0.94). However, patients undergoing EVAR had significantly less estimated blood loss (median: 0.3 vs. 3.0L, P<0.0001) and transfusion requirement (median: 5.0 vs. 9.0 U, P=0.0041). Furthermore, although there was no significant difference in length of overall hospital stay between the 2 groups (8.5 vs. 15days in the OR group, P=0.18), significantly more patients in the EVAR group were discharged to home (66.7% vs. 57.1% in the OR group, P=0.03). In contrast to recently published series, this series shows no differences in morbidity or mortality between EVAR or OR of rAAAs. EVAR is appropriate in stable patients with a rAAA and favorable anatomy.