The Morbidity and Mortality Benefit of Endovascular Repair vs Open Repair of Ruptured Abdominal Aortic Aneurysms
Atlee Melillo, M.D., Jose Trani, M.D., Joseph Lombardi, M.D., F.A.C.S..
Cooper University Hospital, Camden, NJ, USA.
Objective(s): This study aims to quantify the associated morbidity and mortality benefit of endovascular repair (EVAR) compared to open repair (OPEN) of ruptured abdominal aortic aneurysms.
Methods: Using the NSQIP database, all ruptured abdominal aortic aneurysms from 2012-2015 were analyzed based on repair type. OPEN repair was compared to EVAR for 30-day mortality, and secondary endpoints including post-operative lower extremity ischemia, proximal aneurysm extent (infrarenal, juxtarenal, pararenal and suprarenal) using Fisher's exact tests for morbidity and morality and either Chi-squared or Wilcoxon Two-Sample tests for other secondary endpoints.
Results: There were 583 total infrarenal ruptured abdominal aortic aneuryms from 2012-2015. Of those cases, 210 were OPEN and 373 were ENDO. Both OPEN and ENDO groups showed no statistically significant difference in gender, race, age or BMI. Thirty day mortality for OPEN repairs of infrarenal abdominal aortic aneuryms was 30% (63/210) and 17% (64/373) for ENDO repairs (p=.0005). No significant difference was found between the OPEN and EVAR repair groups for juxtarenal, pararenal or suprarenal extent. Incidence of lower extremity ischemia for OPEN repairs was 7% (28/367) and 3% (14/436) for ENDO repairs (p=.01).
Conclusions: Ruptured abdominal aortic aneurysms undergoing ENDO repair had a clear survival benefit and reduced incidence of lower extremity ischemia when compared with OPEN repair. The feasibility of endovascular repair should be strongly considered with all patients presenting with infrarenal aortic aneurysms.
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