Should open repair be the choice in ruptured abdominal aortic aneurysm instead of endovascular aortic repair—Experience in a tertiary referral vascular centre

Aim Ruptured abdominal aortic aneurysm (RAAA) is one of the most difficult surgical emergencies with poor outcomes. Aortic occlusion balloon (AOB) can reduce intraoperative mortality and a protocol was made to ensure smooth logistics, which we regard as Protocol II. We herein review the clinical outcomes between endovascular aortic repair (EVAR) and open repair of RAAA. Patients and Methods We conducted a retrospective cohort study of 113 patients with RAAA in 10 years. We measured the primary outcome between two cohorts, EVAR and open repair. Furthermore, we looked into the mortality based on subgroup analysis according to treatment modality and the Queen Elizabeth Hospital physiological classification. Results The overall mortality in Protocol II was significantly lower than that in Protocol I. In the open repair group, the 30‐day mortality was lower in Protocol II, especially in Classes IIb, IIC and III. Protocol II also demonstrated better perioperative outcomes. There was lower 30‐day mortality in EVAR than that in open repair in Protocol I but there was no difference between open repair and EVAR in Protocol II. Conclusion Protocol‐driven management with AOB involving a multidisciplinary team approach can improve survival and perioperative outcomes in RAAA. In those cases with unfavourable anatomy, open repair should be performed. For those class IIA RAAAs, the method of repair should depend on the anatomy, and whether to use AOB should be an individualised decision. In cases of class IIB RAAAs, routine use of AOB can improve survival. For classes IIC and III, we would offer open repair with mandatory use of AOB employing a damage control approach.