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Home > Press Center > Endovascular Therapy Protocol Established by Canadian Researchers

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Emily Kalata
Assistant Director, Communications
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Survival rates and other impacts on patients who have undergone new endovascular therapy protocol for ruptured abdominal aortic aneurysm repair (rAAA) has been published in the March 2007 issue of the Journal of Vascular Surgery.

Randy D. Moore, MD, assistant professor at the University of Calgary, Calgary Health Region in Alberta, Canada, along with other researchers prospectively followed 126 rAAA patients who had an overall reduction in 30-day mortality from 30 to 17 percent after the introduction of their protocol.

Protocol included allowing the blood pressure to remain low to minimize ongoing bleeding; avoiding delays with routine preoperative CT scans, especially for very unstable patients, by using intraoperative angiograms instead; using routine, planned balloon control of the aorta for all cases which reduced the incidence of prolonged shock and hemodynamic instability; and using the faster aorto-uni-iliac device systems for the most unstable patients.

“For the 36 percent of patients we treated with endovascular stenting, the mortality reduction was even more impressive,” said Dr. Moore, “with only 5 percent of patients dying after endovascular repair for rAAA.”

Researchers said one of the more significant findings was that endovascular repair provided a survival benefit to patients with severe shock (blood pressure less than 80mmHg or no recordable blood pressure) at presentation. 

“This group of patients has typically been excluded from endovascular repair in other studies, the mortality rate was 53 percent with conventional open repair, but dropped to 14 percent with endovascular procedures,” added Dr. Moore. “Unstable patients with ruptured aortic aneurysms should not be denied the benefits of this technology and early placement of the balloon. It can save their lives.”

The study also notes that the incidence of rAAA continues to increase despite a 100 percent increase in elective repairs during the past 20 years, the development of screening programs and overall improvements in public and physician awareness. Additionally, the current use of EVAR for rAAA is still low accounting for only six percent of repairs in a study involving nearly 30 percent of the United States population.

“Current literature indicates that EVAR for rAAA results in decreased procedure times, blood loss and length of stay, including the intensive care unit,” added Dr. Moore.  “However we must keep in mind that not all patients are anatomic candidates for EVAR. The purpose of our study was to not indicate that EVAR was the better choice, but we sought to improve the performance of our rAAA program by incorporating EVAR into our protocol.”