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 PS6. A Comparison of Open Surgery vs. Endovascular Repair of "Unstable" Ruptured Abdominal Aortic Aneurysms

​Prateek K. Gupta1, Bala Ramanan2, Travis L. Engelbert1, Girma Tefera1, John R. Hoch1, K. Craig Kent1
1Surgery, University of Wisconsin Hospital and Clinics, Madison, WI; 2Creighton University, Omaha, NE.

OBJECTIVES: Published literature is conflicting regarding the superiority of endovascular (EVAR) repair versus open surgery (OS) for ruptured abdominal aortic aneurysms (rAAA), with data even more limited for unstable rAAAs. Our objectives were to compare 30-day outcomes in patients undergoing OS and EVAR for stable versus unstable rAAAs.
 
METHODS: Patients treated for rAAA were identified from the ACS NSQIP database (2005-2010). Patients were considered unstable if their ASA class was 4 or 5 with one or more of the following: 1) preoperative shock, 2) preoperative transfusion >4 units, 3) preoperative intubation, or 4) preoperative impaired sensorium. Outcomes were 30-day morbidity and mortality.
 
RESULTS: Of 1,447 total patients with rAAA, 654 (45%) were unstable. Preoperative comorbidities and demographics for OS and EVAR were similar for all groups (p>0.05). Outcomes are listed in Table 1. On multivariable analyses, 30-day mortality for EVAR was superior to OS for unstable rAAA (OR 1.74; 95%CI - 1.16-2.62) and also for stable rAAA (OR 1.63; 95%CI - 1.10-2.42). EVAR was also superior to OS for unstable and stable patients with regard to cardiac arrest, renal and respiratory failure (p<0.05 for all).
CONCLUSIONS: EVAR has lower 30-day mortality and morbidity than OS for rAAAs regardless of whether patients are stable or unstable at presentation.
 
AUTHOR DISCLOSURES: T. L. Engelbert: Nothing to disclose; P. K. Gupta: Nothing to disclose; J. R. Hoch: Nothing to disclose; K. Kent: Nothing to disclose; B. Ramanan: Nothing to disclose; G. Tefera: Nothing to disclose.

 

Outcomes (30-day)
Open Surgery
Endovascular Aortic Repair
P value
Ruptured Abdominal Aortic Aneurysm (Unstable)
466
188
Mortality
52.8%
35.6%
<0.0001
Cardiac arrest
24.5%
13.8%
0.001
Acute renal failure needing dialysis
18.7%
12.8%
0.04
Failure to extubate at 48 hours
45.1%
36.2%
0.02
Ruptured Abdominal Aortic Aneurysm (Stable)
482
311
Mortality
26.3%
16.4%
0.001
Cardiac arrest
10.2%
5.5%
0.01
Acute renal failure needing dialysis
13.3%
8.7%
0.047
Failure to extubate at 48 hours
44.6%
15.4%
<0.0001

 

Posted April 2013

  

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