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Home > Vascular Annual Meeting^® > RR10. Open vs. Endoluminal Repair...

RR10. Open vs. Endoluminal Repair of Ruptured Abdominal Aortic Aneurysms: Thirty Day NSQIP Database Outcomes

Eleftherios S. Xenos1,2, Daniel Davenport1, David Minion1,2, Ehab Sorial1,2, Nick Abedi1, Shane O'Keeffe1, Eric Endean1,2
1university of Kentucky Medical Center, Lexington, KY; 2VA Medical Center, Lexington, KY

OBJECTIVES: The mortality of ruptured abdominal aortic aneurysm (rAAA) repair is currently 40-50%. Reports indicate that endovascular repair (EVAR) is feasible for rAAA and may offer potential benefits over open repair. We examined the NSQIP database to compare 30-day multicentre outcomes for EVAR vs. open rAAA repair.

METHODS: Patients that underwent rAAA repair in the NSQIP database from 2005 to 2007 were identified through a combination of CPT codes and ICD-9 diagnoses. Preoperative comorbidities, operative duration and transfusion, and 30 day outcomes were evaluated using T-tests.

RESULTS: 76.8% of patients underwent open repair as shown:

Table 1.
 

Patient characteristics, intraoperative variables and postoperative outcomes are summarized in Table 1.

Patient characteristics: Groups were comparable in terms of comorbid conditions, age and gender; requirement for preoperative blood transfusion indicative of hemodynamic status was similar. Intraoperative variables: Open repair resulted in much higher requirement for blood transfusion (p<0.001) without difference in operating time. Postoperative outcome: Mortality was higher after OR ( p=0.003).There was no difference in the rate of cardiac, neurologic or renal complications but composite morbidity was higher after open repair secondary to wound, septic and pulmonary complications .

CONCLUSIONS: EVAR appears to offer superior 30 day outcomes after repair of rAAA. We did not access aneurysm anatomic characteristics to determine how many patients that had open repair would have been candidates for EVAR .The anatomic suitability for EVAR has been reported at 60% for rAAA. Less that ¼ of the NSQIP database patients underwent EVAR; preoperative albumin which is a strong predictor of morbidity and mortality was significantly lower in patients undergoing open repair. There has been no increase in the ratio of EVAR/open repair in the last two years. EVAR for rAAA with favorable anatomy could potentially result in lower mortality and morbidity as compared to open repair.

AUTHOR DISCLOSURES: E.S. Xenos, None; D. Davenport, None; D. Minion, Gore; E. Sorial, None; N. Abedi, None; S. O'Keeffe, None; E. Endean, None.