Why the study?
Does endovascular repair reduce 30-day mortality compared to open repair in patients with ruptured abdominal aortic aneurysms?
Does endovascular repair reduce 30-day mortality compared to open repair in patients with ruptured abdominal aortic aneurysms?
Endovascular repair of ruptured abdominal aortic aneurysms is associated with significantly lower 30-day mortality compared to open repair.
May support EVAR consideration in ruptured AAA; leaves open confirmation by randomized trials before practice change.
PURPOSE: To determine whether endovascular repair (EVAR) offers a survival advantage over open repair (OAR) with ruptured abdominal aortic aneurysms (RAAA). METHODS: Retrospective analysis of RAAA patients treated between 2003 and 2008. Univariate and multivariate analyses were performed. RESULTS: 167 patients presented with RAAA (OAR = 135, 80.8%, EVAR = 32, 19.2%). On univariate analysis, EVAR was associated with a decreased mortality relative to OAR, (15.6% vs 43.7%, P = .004). Patients who survived were younger (P < .0005), had a higher blood pressure (P < .0005), level of consciousness (P < .0005), and hemoglobin (P = .018), and a lower urea (P = .005) and international normalized ratio (INR; P = .001). On multivariate analysis, type of repair remained an independent predictor of 30-day mortality (OR: 0.121; 95% CI: 0.021-0.682, P = .017). CONCLUSION: Controlling for preoperative factors, EVAR is an independent predictor of lower 30 day mortality relative to open repair after RAAA. This supports the wider use of endovascular repair in all patients with RAAA.
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Chagpar et al. (2010) studied this question.
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