Key result
Emergency EVAR for ruptured acute abdominal aortic aneurysms was associated with significantly lower 30-day mortality compared to open surgery (20% vs 45%, P=0.021).
Why the study?
Does emergency endovascular aneurysm repair (eEVAR) reduce mortality compared to open surgery in patients with acute abdominal aortic aneurysms?
Observational (n=240)
No
Does emergency endovascular aneurysm repair (eEVAR) reduce mortality compared to open surgery in patients with acute abdominal aortic aneurysms?
Absolute Event Rate: 20% vs 45%
p-value: p=0.021
Emergency endovascular aneurysm repair (eEVAR) significantly reduces early and mid-term mortality compared to open surgery in patients with ruptured acute abdominal aortic aneurysms, though it may be associated with late aneurysm-related mortality.
May support eEVAR preference in ruptured AAA but should not yet change practice; leaves open need for randomized confirmation.
The aim of the paper is to prospectively describe early and mid-term outcomes for emergency endovascular aneurysm repair (eEVAR) versus open surgery in acute abdominal aortic aneurysms (aAAAs), both unruptured (symptomatic) and ruptured. We enrolled all consecutive patients treated for aAAA at our center between April 2002 and April 2008. The main outcome parameters were 30-day, 6- and 12-month mortality (all-cause and aneurysm-related). Two hundred forty patients were enrolled in the study. In the unruptured aAAA group (n = 111), 47 (42%) underwent eEVAR. The 30-day, 6- and 12-month mortality rates were 6, 13 and 15% in the eEVAR group versus 11% (NS), 13% (NS) and 16% (NS) in the open group, respectively. In the ruptured aAAA group (n = 129), 25 (19%) underwent eEVAR (mortality rates: 20, 28 and 36%, respectively) compared with 104 (81%) patients who underwent open surgery (mortality rates: 45% (P = 0.021), 60% (P = 0.004) and 63% (P = 0.014), respectively). In conclusion, the present study showed a reduced 30-day, 6- and 12-month mortality of eEVAR compared with open surgery in all patients with aAAA, mainly due to a lower mortality in the ruptured aAAA group. Late aneurysm-related mortality occurred only in the eEVAR group.
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Bosch et al. (2012) conducted an observational in Acute abdominal aortic aneurysms (unruptured and ruptured) (n=240). Emergency endovascular aneurysm repair (eEVAR) vs. Open surgery was evaluated on 30-day mortality in ruptured acute abdominal aortic aneurysms (p=0.021). Emergency EVAR for ruptured acute abdominal aortic aneurysms was associated with significantly lower 30-day mortality compared to open surgery (20% vs 45%, P=0.021).
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