Collected World and Single Center Experience with Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

Background

Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial.

Objective

To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers.

Methods

Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible, and treatment details were included from a single center and information on 1,037 patients treated by EVAR and 763 patients treated by open repair (OR).

Results

Overall 30-day mortality after EVAR in 1,037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean 49.1%) of their patients, had a 30-day mortality of 19.7% (range: 0%–32%) for 680 EVAR patients and 36.3% (range: 8%–53%) for 763 OR patients (P < 0.0001). Supraceliac aortic balloon control was obtained in 19.1% ± 12.0% (SD) of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% ± 8.3% (±SD) of these EVAR patients.

Conclusion

These results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is better than OR for treating RAAA patients provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.