What does this research mean for the field?

Each 16 mm increase in aneurysm neck length is associated with reduced 30-day mortality overall and after open repair of ruptured abdominal aortic aneurysm. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether aneurysm shape and anatomical extent, which dictate eligibility for endovascular repair, affect mortality and reintervention rates following endovascular or open surgical repair in ruptured abdominal aortic aneurysm.

August 23, 2026European Heart JournalOpen Access

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Q: What are the key findings of this study?

Each 16 mm increase in aneurysm neck length was associated with a 28% reduction in 30-day mortality (adjusted OR 0.72, 95% CI 0.57-0.92, p=0.009).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Ruptured abdominal aortic aneurysm (rAAA) (n=458). Intervention: Aneurysm neck length (per 16 mm increase) vs. Shorter aneurysm neck length. Primary outcome: Mortality within 30 days of randomization (OR 0.72, 95% CI 0.57, 0.92, p=0.009).

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Key result

Longer aneurysm neck length linked to ~28% lower 30-day mortality per 16 mm.

OR 0.72
95% CI 0.57, 0.92
P=0.009
n=458

Why the study?

To investigate whether aneurysm shape and extent, which indicate EVAR eligibility in ruptured abdominal aortic aneurysm, influence outcomes of both EVAR and open surgical repair.

Does aneurysm neck length influence 30-day mortality in patients undergoing repair for ruptured abdominal aortic aneurysm?

Population

458 patients with proven rAAA undergoing repair in the IMPROVE trial

Comparison

Six aortic morphological parameters evaluated across EVAR vs open repair

Design

Cohort analysis of randomized trial participants

Follow-up

30 days

Authors

AAA. AnjumNishtar Medical College and Hospital LTLouise ThompsonCedars-Sinai Medical Center BABilal AzharSt George’s University Hospitals NHS Foundation Trust

Discussion

Member takes

Implication

Short neck length may predict higher 30-day mortality after ruptured AAA repair; leaves open whether morphology explains EVAR observational benefit.

Key Points

To determine whether aneurysm shape and anatomical extent, which dictate eligibility for endovascular repair, affect mortality and reintervention rates following endovascular or open surgical repair in ruptured abdominal aortic aneurysm.
Secondary analysis of 458 patients (364 men, mean age 76 years) with proven ruptured abdominal aortic aneurysm randomized before morphological assessment in the IMPROVE trial (ISRCTN 48334791).
Six baseline morphological parameters were assessed by a core laboratory on admission CT scans: maximum aortic diameter, aneurysm neck diameter, length, conicality, proximal neck angle, and maximum common iliac diameter.
Outcomes evaluated were 30-day mortality, 24-hour mortality, and 30-day reinterventions across patients commencing endovascular repair (n = 177) or open surgical repair (n = 281).
Aneurysm neck length was significantly shorter in patients undergoing open repair versus endovascular repair (mean 19.5 mm vs. 29.2 mm, P < 0.001).
Aneurysm neck length was inversely associated with 30-day mortality overall, with an adjusted OR of 0.72 (95% CI 0.57, 0.92; P = 0.009) for each 16 mm (1 SD) increase in length, and with 24-hour mortality (adjusted OR 0.66, 95% CI 0.48, 0.90; P = 0.008).
Morphological parameters showed no convincing association with 30-day reinterventions, with 88 reinterventions observed among 412 evaluable patients.

Study Design

Type

Observational (n=458)

Multicenter

Yes

Structured PICO

Does aneurysm neck length influence 30-day mortality in patients undergoing repair for ruptured abdominal aortic aneurysm?

Population

458 patients (mean age 76.1, 20.5% female) with ruptured abdominal aortic aneurysm who underwent repair, analyzed observationally to assess the impact of aortic morphology on 30-day mortality.

Exposure

Aneurysm neck length (analyzed as a continuous morphological exposure, per 16 mm increase)

Comparator

Shorter aneurysm neck length

Outcome

Mortality within 30 days of randomizationhard clinical

Main Result

Odds Ratio: 0.72 (95% CI 0.57–0.92)

p-value: p=0.009

Short aneurysm neck length is a major independent predictor of early mortality after open repair of ruptured AAA, which may explain the apparent survival benefit of EVAR in observational studies.

Limitations

Observational as-treated analysis subject to patient selection bias
Excluded moribund patients who died without aneurysm repair
Limited statistical power for reintervention outcomes due to few events

Cite This Study

Anjum et al. (2015) conducted an observational in Ruptured abdominal aortic aneurysm (rAAA) (n=458). Aneurysm neck length (per 16 mm increase) vs. Shorter aneurysm neck length was evaluated on Mortality within 30 days of randomization (OR 0.72, 95% CI 0.57, 0.92, p=0.009). Each 16 mm increase in aneurysm neck length was associated with a 28% reduction in 30-day mortality (adjusted OR 0.72, 95% CI 0.57-0.92, p=0.009).

synapsesocial.com/papers/6a8a8784fe5cd1eb460deef1 https://doi.org/10.1093/eurheartj/ehu521

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Implication

Short neck length may predict higher 30-day mortality after ruptured AAA repair; leaves open whether morphology explains EVAR observational benefit.

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider