Early and Long-term Outcomes of Adjunctive Fibrin Glue Sac Filling during Emergency Endovascular Repair for Ruptured Abdominal Aortic Aneurysm

Q: What are the key findings of this study?

Adjunctive fibrin glue sac filling during emergency EVAR for ruptured AAA independently reduced 30-day mortality (OR 0.174, P=0.004) and overall mortality (HR 0.248, P<0.001) vs standard EVAR.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ruptured abdominal aortic aneurysm (rAAA) (n=179). Intervention: Adjunctive fibrin glue sac filling (FGSF) during emergency endovascular aneurysm repair vs. Standard emergency endovascular aneurysm repair (rEVAR) alone. Primary outcome: 30-day mortality (OR 0.174, 95% CI 0.049-0.529, p=0.004).

Q: What does this research mean for the field?

Adjunctive fibrin glue sac filling during emergency endovascular repair for ruptured abdominal aortic aneurysm independently reduces 30-day mortality, overall mortality, and early reintervention compared with standard endovascular repair. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yonghui Chen; Jiayin Guo; Xiaohang Song; 刘卫平; Xiangchen Dai; Yan Song

doi:10.21203/rs.3.rs-11073273/v1

October 27, 2026Open Access

Early and Long-term Outcomes of Adjunctive Fibrin Glue Sac Filling during Emergency Endovascular Repair for Ruptured Abdominal Aortic Aneurysm

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Key result

Adjunctive fibrin glue sac filling during emergency EVAR linked to ~83% lower 30-day mortality.

OR 0.174
95% CI 0.049-0.529
P=0.004
n=179

Why the study?

Persistent hemorrhage at the rupture site after endovascular aneurysm repair (EVAR) may contribute to early mortality in patients with ruptured abdominal aortic aneurysm (rAAA), motivating evaluation of the efficacy of adjunctive fibrin glue sac filling (FGSF) during emergency rEVAR.

Does adjunctive fibrin glue sac filling during emergency endovascular aneurysm repair reduce 30-day mortality and improve long-term survival in patients with ruptured abdominal aortic aneurysm?

Key Points

To evaluate the efficacy and outcomes of adjunctive fibrin glue sac filling during emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysm.
Two-center retrospective cohort study of 179 consecutive patients undergoing emergency rEVAR for rAAA between January 2010 and December 2024.
Patients were categorized by standard rEVAR (n=127) versus adjunctive FGSF (n=52), followed by 1:1 propensity score matching (n=50 per group).
In the matched cohort, FGSF resulted in significantly lower 30-day mortality (12% vs. 20%, P=0.048), early endoleak (2% vs. 18%, P=0.016), and early reintervention (2% vs. 18%, P=0.016).
Patients in the FGSF group required significantly lower plasma transfusion volume (400 vs. 800 mL, P=0.04) and packed red blood cell transfusion volume (400 vs. 800 mL, P=0.045).
Multivariable analysis identified FGSF as an independent protective factor against 30-day mortality (OR=0.174, 95% CI: 0.049–0.529, P=0.004) and overall mortality (HR=0.248, 95% CI: 0.122–0.505, P<0.001).

Study Design

Type

Cohort (n=179)

Multicenter

Yes

Structured PICO

Does adjunctive fibrin glue sac filling during emergency endovascular aneurysm repair reduce 30-day mortality and improve long-term survival in patients with ruptured abdominal aortic aneurysm?

P

Population

179 adults (mean age 69.6 years, 16.2% female) with ruptured abdominal aortic aneurysm undergoing emergency endovascular aneurysm repair, followed for a median of 36.5 months.

E

Exposure

Emergency endovascular aneurysm repair (rEVAR) combined with adjunctive fibrin glue sac filling (FGSF), where fibrin glue solutions were injected into the aneurysm sac via a pre-positioned 5-F catheter following main body and iliac limb deployment and proximal aortic balloon inflation (volume matched to maximum aneurysm diameter at a 1:1 ratio, e.g., 6 vials for a 6-cm aneurysm).

C

Comparator

Standard emergency endovascular aneurysm repair (rEVAR) alone without adjunctive fibrin glue sac filling (both groups underwent standard EVAR, chimney EVAR, or fenestrated EVAR).

O

Outcome

30-day mortality (defined as death occurring within 30 days after the rEVAR procedure, including intraoperative deaths after successful endograft deployment and all in-hospital deaths after rEVAR) and long-term overall survival (at median follow-up of 36.5 months).hard clinical

Main Result

Odds Ratio: 0.174 (95% CI 0.049–0.529)

p-value: p=0.004

Adjunctive fibrin glue sac filling during emergency endovascular repair for ruptured abdominal aortic aneurysm is associated with reduced perioperative blood transfusion requirements, lower 30-day mortality, and sustained reductions in reintervention rates compared to standard endovascular repair alone.

Limitations

Retrospective design carrying residual indication and survivorship bias
Long study duration with potential confounding from improvements in perioperative management over time
Inherent learning curve associated with the fibrin glue sac filling technique
Relatively limited sample size reducing statistical power after propensity score matching
Retrospective design carrying residual bias risk, including potential indication bias from off-label sac filling technique and survivorship bias from excluding patients who died prior to complete endograft deployment
Long study duration (2010 to 2024) during which FGSF was introduced, meaning improvements in perioperative management over time cannot be completely excluded
Inherent learning curve for the FGSF procedure requiring experience for safe and effective delivery

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Implication

Fibrin glue sac filling was associated with lower mortality after emergency rEVAR; hypothesis-generating and requires randomized confirmation before practice change.

Abstract

Background : Persistent hemorrhage at the rupture site after endovascular aneurysm repair (EVAR) may be the risk of early mortality in patients with ruptured abdominal aortic aneurysm (rAAA). This study aimed to evaluate the efficacy of adjunctive fibrin glue sac filling (FGSF) in emergency ruptured EVAR (rEVAR) for rAAA patients. Methods : A two-center retrospective cohort study was conducted on consecutive patients who underwent emergency rEVAR for rAAA at three tertiary referral centers from January 2010 to December 2024. Patients were classified by whether adjunctive FGSF was performed. The primary outcome was 30-day mortality and long-term survival. Statistical analyses included propensity score matching (PSM), Lasso regression, logistic regression, Cox proportional hazards regression, landmark analysis, and Kaplan–Meier survival analysis. Results : A total of 179 patients were included. After1:1 PSM, 50 patients were matched in each group. Compared with the standard rEVAR group, FGSF exhibited lower requirement of plasma (400 vs. 800 mL, P=0.04) and packed red blood cell transfusion volume (400 vs. 800 mL, P=0.045), and lower rates of early endoleak (2 vs. 18%, P=0.016), early reintervention (2 vs. 18%, P=0.016), and 30-day mortality (12 vs. 20%, P=0.048). Overall survival was also higher for FGSF (median follow-up 36.5 months; P=0.002) than standard rEVAR, but landmark analysis of hospital survivors showed similar long-term survival (median follow-up 48 months; P=0.06). Landmark analysis further demonstrated that FGSF was associated with a lower reintervention rate among hospital survivors (P = 0.041). Multivariable analyses confirmed that FGSF was an independent protective factor against 30-day mortality (OR=0.174, 95%CI: 0.049–0.529, P=0.004), as well as overall mortality (HR=0.248, 95%CI: 0.122–0.505, P<0.001). Conclusions : Adjunctive FGSF was associated with reduced mortality after emergent rEVAR for rAAA. The survival benefit appeared to be confined to the early postoperative period, whereas the reduction in reintervention risk seemed sustained. Further high-quality, prospective multicenter studies are required to validate these findings.

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Cite This Study

Chen et al. (2026) conducted a cohort in Ruptured abdominal aortic aneurysm (rAAA) (n=179). Adjunctive fibrin glue sac filling (FGSF) during emergency endovascular aneurysm repair vs. Standard emergency endovascular aneurysm repair (rEVAR) alone was evaluated on 30-day mortality (OR 0.174, 95% CI 0.049-0.529, p=0.004). Adjunctive fibrin glue sac filling during emergency EVAR for ruptured AAA independently reduced 30-day mortality (OR 0.174, P=0.004) and overall mortality (HR 0.248, P<0.001) vs standard EVAR.

synapsesocial.com/papers/6aee6bb371a7594806220a95 https://doi.org/10.21203/rs.3.rs-11073273/v1

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Early and Long-term Outcomes of Adjunctive Fibrin Glue Sac Filling during Emergency Endovascular Repair for Ruptured Abdominal Aortic Aneurysm

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Early and Long-term Outcomes of Adjunctive Fibrin Glue Sac Filling during Emergency Endovascular Repair for Ruptured Abdominal Aortic Aneurysm

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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