Luigi Pascarella, Richard McCann, Matthew A. Schechter, Leila Mureebe
Duke University Hospital, Durham, NC.
OBJECTIVES: The mortality of ruptured infrarenal abdominal aortic aneurysms (rAAA) is as high as 70%. Loss of consciousness and systolic blood pressure on presentation of less than 80mmHg are the most important predictors of mortality after emergent open repair (OR). Endovascular repair of abdominal aortic aneurysm (EVAR) has reduced short-term operative mortality and morbidity for elective abdominal aortic aneurysm repair and many have advocated for wider application of EVAR for rAAA. The objective of this study is to compare our experience with OR and EVAR management of rAAA.
METHODS: A retrospective review of all rAAA presenting to our institution from 2000-2011 was performed. Patients were grouped based on the surgical approach taken (OR or EVAR). Demographics, co-morbidities, mortality and morbidity rates were compared. Statistical analyses were conducted with Stata, version 12.
RESULTS: One hundred forty-five patients presented with rAAA over the study period. Twenty-two percent of patients underwent EVAR, 64% underwent OR and 14% declined repair. A preoperative computed tomography scan was available in 99 patients. Only one patient (0.69%) required conversion to OR from EVAR. There was no statistical difference in 30-day (EVAR: 25%, OR40%, p=0.12) and 1-year (EVAR: 31.25%, OR45.74% p=0.5) mortality rates. Morbidity was 78% in the EVAR and 75% in OR group. Respiratory failure and abdominal compartment syndrome were the major complications in the patients undergoing EVAR, while respiratory and renal failure were most common in the patients undergoing OR.
CONCLUSIONS: In contrast to recently published series, this review shows no difference in clinical outcome between EVAR and OR in the treatment of rAAA. The comorbidities and the clinical status of the patient upon arrival to the hospital remain the most important prognostic predictors of morbidity and mortality. Until randomized trial data are available, these results lead us to pursue EVAR for rAAA in stable patients with favorable anatomy rather than a more universal approach.
AUTHOR DISCLOSURES: R. McCann: Nothing to disclose; L. Mureebe: Nothing to disclose; L. Pascarella: Nothing to disclose; M. A. Schechter: Nothing to disclose.
Posted April 2013