Abdominal Aortic Endografting

EVAR Suitability is not a Predictor for Early and Midterm Mortality after Open Ruptured AAA Repair

Ten Bosch JA, Willigendael EM, van Sambeek MRHM, et al (Atrium Med Ctr Parkstad, Heerlen, The Netherlands; Catharina hosp, Eindhoven, The Netherlands; et al) Eur J Vasc Endovasc Surg 41:647–651, 2011^§

Abstract

Objective

The reported mortality reduction of emergency endovascular aneurysm repair (eEVAR) compared with open repair in patients with a ruptured abdominal aortic aneurysm (rAAA), as observed in observational studies, might be flawed by selection bias based on anatomical suitability for eEVAR. In the present study, we compared mortality in EVAR suitable versus non-EVAR-suitable patients with a ruptured AAA who were all treated with conventional open repair.

Materials and Methods

In all patients presenting with a suspected rAAA, computed tomography angiography (CTA) scanning was performed. All consecutive patients with a confirmed rAAA on preoperative CTA scan and treated with open repair between April 2002 and April 2008 were included. Anatomical suitability for eEVAR was determined by two blinded independent reviewers. Outcomes evaluated were mortality (intra-operative, 30-day, and 6-month), morbidity, complications requiring re-intervention and length of hospital stay.

Results

A total of 107 consecutive patients presented with a rAAA and underwent preoperative CTA scanning. In 25 patients, eEVAR was performed. In the 82 patients who underwent open repair, CTA showed an EVAR-suitable rAAA in 33 patients (41.8%) and a non-EVAR-suitable rAAA in 49 patients. Thirty-day and 6-month mortality rate was 15/33 (45.5%; 95% confidence interval (CI) 28.1–63.7) and 18/33 (54.5%; 95% CI 36.4–71.9) in the EVAR-suitable group versus 24/49 (49.0%; 95% CI 34.4–63.7) (P = 0.75) and 29/49 (59.2%; 95% CI 44.2–73.0) (P = 0.68) in the non-EVAR-suitable group, respectively.

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