Treatment of Abdominal Aortic Aneurysm Ruptures in a Well-defined Geographical Area during 2012–2020—A Paradigm Shift

Abstract

The treatment of abdominal aortic aneurysm ruptures (rAAA) has changed from open to endovascular repair during last decade. The immediate survival benefit after endovascular treatment method is well known, yet without conclusive support from randomized controlled studies. The aim of this study is to report the survival benefit of endovascular repair during the transition between two treatment methods and to highlight the in-hospital protocol for rAAA patients, with continuous simulation training and a designated team. This study is a retrospective review of rAAA patients diagnosed at Helsinki University Hospital during 2012-2020, including total of 263 patients. Patients were divided by treatment method, and the primary end point was 30-day mortality. The secondary endpoints were 90-days mortality, one-year mortality, and the length of stay in intensive care. Patients were divided into the endovascular repair group (rEVAR n = 119) and open repair group (rOR n = 119). The turn-down rate was 9.5% (n = 25). The 30-day short-term survival favored endovascular treatment (rEVAR 83.2% vs rOR 68.9%, p = 0.015). The 90-day post-discharge survival was higher in the rEVAR group (rEVAR 80.7% vs rOR 67.2%, p = 0.026). One-year survival was also higher in the rEVAR group, however with less statistical significance (rEVAR 74.8% vs rOR 64.7%, p = 0.120). The effect of the revised rAAA protocol was seen in improved survival, when comparing the first three years of the cohort (2012- 2014) to the last three years of the cohort (2018-2020). Survival rates were higher at 30 days, 90 days, and one year in the late cohort (74% vs 84%, 72% vs 81%, and 70% vs 77%). REVAR has its place as a first-line treatment option for most patients and reduces short- and midterm mortality at least to one-year follow-up compared to open repair. Dedicated vascular surgeons for rEVAR as well as continuous simulation training for the operating room staff are key elements of a low turn-down and successful rAAA treatment. The use of an occlusive aortic balloon reduces overall mortality in both operative methods.