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PVSS10. A Meta-Analysis Of Endovascular Repair Of Ruptured Abdominal Aortic Aneurysms

Ali Azizzadeh, Martin A. Villa, Charles C. Miller, Anthony L. Estrera, Sheila M. Coogan, Hazim J. Safi.
University of Texas Health Science Center, Houston, Texas

OBJECTIVES: Endovascular repair is being increasingly reported for treatment of ruptured abdominal aortic aneurysms. The aim of this study was to estimate the overall mortality of patients who undergo endovascular repair for treatment of ruptured abdominal aortic aneurysms.

METHODS: A meta-analysis of the English language literature was performed. 274 publications were reviewed. 31 publications representing 773 patients were included in the meta-analysis. Data were analyzed by weighted least squares regression.

RESULTS: The average age was 74. Fifteen percent of patients were female. Preoperative computed tomography scanning was performed in 86.6% of patients. 11.5% of patients underwent endovascular repair using aorto-uniiliac grafts. The remainder underwent bifurcated graft placement. The overall technical success rate was 95%. The overall weighted mortality was 27.9 %. Percent of case mix done endovascularly (ratio of endovascular cases to total number of cases) was a strong predictor of mortality (weighted coefficient -0.25, p<0.008).

CONCLUSIONS: Mortality following endovascular repair of abdominal aortic aneurysms is 27.9 percent. Experience of the center treating the rupture appears to play a significant role in outcome, with a 2.5% reduction in mortality observed for each 10% increase in the precentage of ruptures repaired endovascularly. This relationship does not hold for total abdominal aortic aneurysms repair experience, only for the ratio of endovascular to total cases.