Ann Surg Treat Res.
2021 May;100(5):291-297. 10.4174/astr.2021.100.5.291.
Outcomes of emergency endovascular versus open repair for abdominal aortic aneurysm rupture
- Affiliations
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- 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 2Department of Traumatology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- 3Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
- 4Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, Korea
- KMID: 2515337
- DOI: http://doi.org/10.4174/astr.2021.100.5.291
Abstract
- Purpose
Ruptured abdominal aortic aneurysm (rAAA) is one of the most common aortic emergencies in vascular surgery and is associated with high operative mortality and morbidity rates despite recent treatment advances. We evaluated operative mortality risks for the outcomes of emergency endovascular aneurysm repair (eEVAR) vs. open repair in rAAA.
Methods
Twenty patients underwent eEVAR (n = 12) or open repair (n = 8) for rAAA between 2016 and 2020. We adopted the EVAR first strategy since 2018. Primary endpoints included in-hospital mortality and 1-year survival. The outcome variables were analyzed with Fisher exact, Mann-Whitney test, and linear by linear association. The Kaplan-Meier method was used to estimate survival.
Results
There were 13 males (65.0%) and the median age of the study cohort was 78.0 years (range, 49–88 years). Inhospital mortality occurred in 7 patients (35.0%); 5 (50.0%) in the early period and 2 (20.0%) in the later period of this series. According to the procedure type, 4 (50.0%) and 3 (25.0%) in-hospital mortalities occurred in the open repair and eEVAR patients, respectively. In 6 patients (50.0%), eEVAR was performed on unfavorable anatomy. The 1-year survival of eEVAR vs. open repair group was 75% ± 12.5% and 50% ± 17.7%, respectively. On univariate analysis, preoperative highrisk indices, postoperative acute renal failure requiring dialysis, pulmonary complications, and prolonged mechanical ventilation were associated with higher operative mortality.
Conclusion
The current data showed relatively superior outcomes with eEVAR vs. open repair for rAAA, even in some patients with unfavorable anatomy supporting the feasibility, efficacy, and safety of EVAR first strategy.
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