Why the study?
What is the mortality rate of endovascular repair for ruptured abdominal aortic aneurysms, and how does center experience affect it?
What is the mortality rate of endovascular repair for ruptured abdominal aortic aneurysms, and how does center experience affect it?
Endovascular repair of ruptured abdominal aortic aneurysms has a mortality rate of approximately 30%, which significantly improves as centers perform a higher proportion of cases endovascularly, suggesting a strong learning curve effect.
Supports centralizing RAAA care at high-EVAR centers; extends volume-outcome evidence to ruptured cases.
Endovascular repair is increasingly used for ruptured abdominal aortic aneurysms (RAAAs). This study estimated the mortality rate for this approach. A review of 307 publications in English was performed. Thirty-four publications representing 1,200 patients with RAAA were deemed appropriate for analysis by weighted least squares regression. Of the 1,200 patients, 531 (44.3%) underwent endovascular aneurysm repair (EVAR). The average age was 74 years, and 13% were female. Aortouni-iliac grafts were used in 49.4% of patients, and 50.6% received bifurcated grafts. The technical success rate was 94.9%, with a mortality rate of 30.2%. The ratio of endovascular cases to the total number of cases strongly predicted the mortality rate (weighted coefficient -0.378, p< .0003). The mortality rate following EVAR of RAAA is 30%. A 3.8% reduction in mortality was found for each 10% increase in the percentage of ruptures repaired endovascularly at each center. These results are suggestive of a learning curve.
No takes yet. Share an insight, caveat, or question.
Azizzadeh et al. (2008) studied this question.
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: