J C 2010
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This study compared outcomes of endovascular repair (rEVAR) versus open surgery for ruptured abdominal aortic aneurysms (rAAA) in patients suitable for rEVAR. The study found lower mortality rates after rEVAR compared to open surgery at intraoperative, 30-day, and 6-month follow-up in suitable patients. Length of hospital stay was also shorter for rEVAR. The results suggest rEVAR provides superior outcomes to open surgery for rAAA in patients suitable for the endovascular approach.
J C 2010
- 1. DR IMRAN JAVED, MBBS, FCPS. INTERNATIONAL FELLOW Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients
- 2. OBJECTIVE OF THE STUDY Efficacy results of endovascular repair (rEVAR) for ruptured abdominal aortic aneurysm (rAAA) compared with open surgery are based on several observational studies containing selection bias. The present study compared rEVAR with open surgery in EVAR-suitable patients with an rAAA who all underwent the same preoperative imaging protocol.
- 3. METHODS Our policy is to perform a computed tomography angiography on all patients with a suspected rAAA. rEVAR was performed when the rEVAR-vascular surgeon was on call and the patient was suitable for EVAR.
- 4. METHODS Afterwards, two experienced independent blinded experts assessed all computed tomography angiography (CTA) scans on EVAR-suitability. Only EVAR-suitable patients were included in the main analyses. Outcome parameters included mortality (intraoperative, 30-day, and 6-month), complications, reinterventions, and length of hospital stay.
- 6. RESULTS From April 2002 until March 2008, 132 consecutive patients with suspected rAAAs were presented. Preoperative CTA confirmed rAAA in 104 patients, of whom 25 underwent rEVAR, and 79 underwent open surgery. In retrospect, the 25 rEVAR patients and 33 patients in the open group were judged EVAR-suitable by the experts.
- 8. RESULTS At baseline, there was an equal distribution of physiologic and anatomic characteristics as well as comorbidity. In EVAR-suitable patients, the intraoperative, 30-day, and 6-month mortality was 4.0% (1 of 25), 20.0% (5 of 25), and 28.0% (7 of 25) after rEVAR compared with 6.1% (2 of 33; P >.99), 45.5% (15 of 33; P = .04), and 54.5% (18 of 33; P = .04) after open surgery, respectively.
- 9. RESULTS Median length of hospital stay was 9.5 days (interquartile range, 5.0-20.5) after rEVAR and 17.0 days (interquartile range, 9.5-28.0) after open surgery (P = .03).
- 10. CONCLUSION In EVAR-suitable patients, an absolute perioperative mortality reduction of 25.5% of rEVAR over open surgery was found, which was still present at 6 months of follow-up. These data suggest that rEVAR is a superior treatment option for EVAR-suitable patients with an rAAA compared with an open surgery.