Key result
EVAR-only strategy shows no 30-day mortality benefit over an EVAR-selected approach for ruptured aortic aneurysms.
Why the study?
The study aimed to review institutional management experience of ruptured abdominal aortic aneurysms using an EVAR-only strategy and discuss its feasibility.
Does an EVAR-only strategy reduce mortality compared to an EVAR-selected strategy in patients with ruptured abdominal aortic aneurysms?
Cohort (n=93)
No
Does an EVAR-only strategy reduce mortality compared to an EVAR-selected strategy in patients with ruptured abdominal aortic aneurysms?
An EVAR-only strategy for ruptured abdominal aortic aneurysms is feasible and yields similar mortality to an EVAR-selected strategy, while simplifying the treatment algorithm.
Answers are grounded in this paper and cite their sources.
EVAR-only yields comparable mortality to EVAR-selected in ruptured AAA; hypothesis-generating for simplified protocols pending randomized data.
Objectives The aim of this study was to review our management experience of ruptured abdominal aortic aneurysms (RAAAs) using an endovascular aneurysm repair (EVAR)-only strategy, and discuss the feasibility of this strategy. Materials and methods A retrospective analysis of clinical data was performed in patients with RAAAs from January 2009 to October 2020. Our strategy toward operative treatment for RAAAs evolved from an EVAR-selected (from January 2009 to April 2014) to an EVAR-only (from May 2014 to October 2020) strategy. Baseline characteristics, thirty-day mortality, perioperative complications, and long-term outcomes of patients were compared between the two periods. Results A total of 93 patients undergoing emergent RAAA repair were eventually included. The overall operation rate in RAAAs at our centre was 70.5% (93/132). In the EVAR-only period, all 53 patients underwent ruptured endovascular aneurysm repair (rEVAR). However, only 47.5% (19/40) of patients in the EVAR-selected period underwent rEVAR, and the remaining 21 patients underwent emergent open surgery. Thirty-day mortality in the EVAR-only group was 22.6% (12/53) compared with 25.0% (10/40) for the EVAR-selected group (P= 0.79). Systolic blood pressure ≤70 mmHg [adjusted odds ratio (OR) 4.99, 95% confidence interval (CI), 1.13–22.08,P= 0.03] and abdominal compartment syndrome (adjusted OR 3.72, 95% CI, 1.12–12.32,P= 0.03) were identified as independent risk factors responsible for 30-day mortality. After 5 years, 47.5% (95% CI, 32.0–63.0%) of patients in the EVAR-selected group were still alive versus 49.1% (95% CI, 32.3–65.9%) of patients in the EVAR-only group (P= 0.29). Conclusion The EVAR-only strategy has allowed rEVAR to be used in nearly all the RAAAs with similar mortality comparing with the EVAR-selected strategy. Due to the avoidance of operative modality selection, the EVAR-only strategy was associated with a more simplified algorithm, less influence on haemodynamics, and a shorter operation and recovery time.
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Fang et al. (2022) conducted a cohort in Ruptured abdominal aortic aneurysms (n=93). EVAR-only strategy vs. EVAR-selected strategy was evaluated on 30-day all-cause mortality (p=0.79). An EVAR-only strategy for the management of ruptured abdominal aortic aneurysms resulted in a 30-day mortality of 22.6%, which was comparable to the 25.0% mortality seen with an EVAR-selected strategy.
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