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PVSS11. A Prospective Analysis of Endovascular Ruptured AAA Repair in Hemodynamically Stable vs. Unstable Patients

Manish Mehta, Sean P. Roddy, Philip S.K. Paty, Yaron Sternbach, John B. Taggert, Stephanie Saltzberg, Paul B. Kreienberg, Kathleen J. Ozsvath, Dhiraj M. Shah, R. Clement Darling, III.
Albany Medical College, Albany, N.Y.

OBJECTIVES: In this prospective study, we compared outcomes of patients with ruptured abdominal aortic aneurysms (r-AAA) that were considered hemodynamically stable (Hd-Stable) to those that were hemodynamically unstable (Hd-Unstable) at presentation, and underwent endovascular aneurysm repair (EVAR).

METHODS: From 2002-2007, 71 patients presented to our institution with r-AAA and underwent endovascular repair with a variety of commercially available stentgrafts. Prior to EVAR, patients were categorized into 2 groups: Hd-Stable with systolic blood pressure (SBP) ≥80 mmHg, and Hd-Unstable with SBP <80 mmHg. All patients were resuscitated and a preoperative CT scan was not deemed necessary for all patients. Data was prospectively collected and statistical analysis was performed using Chi square analysis.

RESULTS: Of the 71 patients with r-AAA that had EVAR, both Hd-Stable (n=49, 69%) and Hd-Unstable (n=22, 31%) patients had similar co-morbidities of CAD (61% vs. 57%), HTN (77% vs. 73%), COPD (29% vs. 23%), and CRI (18% vs. 18%). The 30-day mortality in the Hd-Stable group was significantly less than the Hd-Unstable group (12.2% vs. 31.8%, p<0.05), there was no difference in the need for ‘on-table’ conversion to open surgical repair between the groups (4.1% vs. 4.5%), and the overall mortality of both groups combined was 18.3%. Over a mean follow-up of 18 months, both Hd-Stable and Hd-Unstable groups also had similar incidence of non-fatal complications (40% vs. 39%), and secondary interventions (27% vs. 29%).

Table 1.

CONCLUSIONS: EVAR for r-AAA is feasible in both hemodynamically stable and unstable patients. The mortality of Hd-Stable patients is significantly less than Hd-Unstable patients, and there is no difference in the incidence for conversion to open surgical repair, non-fatal complications, or the need for secondary interventions. Furthermore, the acceptable mortality in Hd-Unstable patients in this series would suggest that hemodynamic instability in patients with r-AAA should not be a contraindication to EVAR.