Article

Ruptured AAA: Suitability for Endovascular Repair is Associated with Lower Mortality Following Open Repair

Corresponding Author

R. Barnes

[email protected]
01482674178 | Fax: 01482674765

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Tel.: 01482674178, Fax: 01482674765, [email protected]Search for more papers by this author

X. Kassianides,

X. Kassianides

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

H. Barakat,

H. Barakat

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

E. Mironska,

E. Mironska

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

R. Lakshminarayan,

R. Lakshminarayan

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

I. C. Chetter,

I. C. Chetter

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

R. Barnes,

Corresponding Author

R. Barnes

[email protected]
01482674178 | Fax: 01482674765

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Tel.: 01482674178, Fax: 01482674765, [email protected]Search for more papers by this author

X. Kassianides,

X. Kassianides

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

H. Barakat,

H. Barakat

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

E. Mironska,

E. Mironska

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

R. Lakshminarayan,

R. Lakshminarayan

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

I. C. Chetter,

I. C. Chetter

Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, HU3 2JZ Hull, UK

Search for more papers by this author

First published: 07 December 2013

https://doi.org/10.1007/s00268-013-2393-y

Citations: 5

Share a link

Email
Wechat
Bluesky

Abstract

Objectives

Perioperative mortality of open repair of ruptured abdominal aortic aneurysms (rAAA) remains unacceptably high: 30-day mortality ≈40 %. This study aimed to assess, quantify, and determine the consequences of anatomic suitability for endovascular repair of rAAA.

Design

A retrospective analysis of the prospectively maintained database identified patients with rAAA.

Methods

Preoperative CT scans were assessed for anatomic suitability for emergency EVAR and precluding factors recorded. Demographic information was collected and analysed for all patients.

Results

A total of 141 patients underwent open surgical repair of rAAA. Forty-six patients had preoperative CT scans suitable for reconstruction. Morphological measurements indicated that 41 % would have been anatomically suitable for EVAR. Suitability was associated with lower mortality rates than unsuitability: 0, 11, and 20 % (24 h, 30 days, and 1 year respectively) versus 11, 33, and 59 % (statistically significant at 1 year; p = 0.02). The groups were comparable excepting diabetes incidence, which was higher in those suitable for EVAR (p = 0.003).

Conclusions

A minority of patients with ruptured AAA are anatomically suitable for EVAR. Anatomical suitability appears to identify patients at low risk from open surgery. Whether this is due to technically less demanding open surgery is unknown. This may be resolved by the IMPROVE trial results, which are eagerly awaited.

Conflict of interest

The authors have no conflict of interest to declare.

Funding

There are no sources of funding to be declared.

References

1ParodiJC, PalmazJC, BaroneHD Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg (1991) 5(6): 491–4991837729 10.1007/BF02015271
10.1007/BF02015271
CAS PubMed Google Scholar
2HinchliffeRJ, BruijstensL, MacSweeneyST, BraithwaiteBD A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysmߝresults of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg (2006) 32(5): 506–51316887369 10.1016/j.ejvs.2006.05.016(discussion 514–515)
10.1016/j.ejvs.2006.05.016
CAS PubMed Web of Science® Google Scholar
3GreenhalghRM, BrownLC, KwongGP, PowellJT, ThompsonSG Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet (2004) 364(9437): 843–84815351191 10.1016/S0140-6736(04)16979-1
10.1016/S0140-6736(04)16979-1
CAS PubMed Web of Science® Google Scholar
4AdriaensenME, BoschJL, HalpernEF, Myriam HuninkMG, GazelleGS Elective endovascular versus open surgical repair of abdominal aortic aneurysms: systematic review of short-term results. Radiology (2002) 224(3): 739–74712202708 10.1148/radiol.2243011675
10.1148/radiol.2243011675
PubMed Web of Science® Google Scholar
5De BruinJL, BaasAF, ButhJ, PrinssenM, VerhoevenEL, CuypersPW et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med (2010) 362(20): 1881–188920484396 10.1056/NEJMoa0909499
10.1056/NEJMoa0909499
CAS PubMed Web of Science® Google Scholar
6ChaikofEL, BrewsterDC, DalmanRL, MakarounMS, IlligKA, SicardGA et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg (2009) 50(4 Suppl): S2–S4919786250 10.1016/j.jvs.2009.07.002
10.1016/j.jvs.2009.07.002
PubMed Web of Science® Google Scholar
7YusufSW, WhitakerSC, ChuterTA, WenhamPW, HopkinsonBR Emergency endovascular repair of leaking aortic aneurysm. Lancet (1994) 344(8937): 16457984027 10.1016/S0140-6736(94)90443-X
10.1016/S0140-6736(94)90443-X
CAS PubMed Web of Science® Google Scholar
8BaxendaleBR, BakerDM, HutchinsonA, ChuterTA, WenhamPW, HopkinsonBR Haemodynamic and metabolic response to endovascular repair of infra-renal aortic aneurysms. Br J Anaesth (1996) 77(5): 581–5858957971 10.1093/bja/77.5.581
10.1093/bja/77.5.581
CAS PubMed Web of Science® Google Scholar
9CuypersPW, GardienM, ButhJ, PeelsCH, CharbonJA, HopWC Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair. Br J Surg (2001) 88(8): 1059–106511488790 10.1046/j.0007-1323.2001.01834.x
10.1046/j.0007-1323.2001.01834.x
CAS PubMed Web of Science® Google Scholar
10BoyleJR, ThompsonJP, ThompsonMM, SayersRD, SmithG, BellPR Improved respiratory function and analgesia control after endovascular AAA repair. J Endovasc Surg (1997) 4(1): 62–659034921 10.1583/1074-6218(1997)004<0062:IRFAAC>2.0.CO;2
10.1583/1074-6218(1997)004<0062:IRFAAC>2.0.CO;2
CAS PubMed Google Scholar
11BoyleJR, GoodallS, ThompsonJP, BellPR, ThompsonMM Endovascular AAA repair attenuates the inflammatory and renal responses associated with conventional surgery. J Endovasc Ther (2000) 7(5): 359–37111032254 10.1583/1545-1550(2000)007<0359:EARATI>2.0.CO;2
10.1177/152660280000700503
CAS PubMed Web of Science® Google Scholar
12PearsonS, HassenT, SparkJI, CabotJ, CowledP, FitridgeR Endovascular repair of abdominal aortic aneurysm reduces intraoperative cortisol and perioperative morbidity. J Vasc Surg (2005) 41(6): 919–92515944585 10.1016/j.jvs.2005.02.040
10.1016/j.jvs.2005.02.040
PubMed Web of Science® Google Scholar
13HoornwegLL, WisselinkW, VahlA, BalmR The Amsterdam Acute Aneurysm Trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg (2007) 33(6): 679–68317276096 10.1016/j.ejvs.2006.12.011
10.1016/j.ejvs.2006.12.011
CAS PubMed Web of Science® Google Scholar
14HarkinDW, DillonM, BlairPH, EllisPK, KeeF Endovascular ruptured abdominal aortic aneurysm repair (EVRAR): a systematic review. Eur J Vasc Endovasc Surg (2007) 34(6): 673–68117719809 10.1016/j.ejvs.2007.06.004
10.1016/j.ejvs.2007.06.004
CAS PubMed Web of Science® Google Scholar
15RoseDF, DavidsonIR, HinchliffeRJ, WhitakerSC, GregsonRH, MacSweeneyST et al. Anatomical suitability of ruptured abdominal aortic aneurysms for endovascular repair. J Endovasc Ther (2003) 10(3): 453–45712932155 10.1583/1545-1550(2003)010<0453:ASORAA>2.0.CO;2
10.1177/152660280301000309
PubMed Web of Science® Google Scholar
16SlaterBJ, HarrisEJ, LeeJT Anatomic suitability of ruptured abdominal aortic aneurysms for endovascular repair. Ann Vasc Surg (2008) 22(6): 716–72218657385 10.1016/j.avsg.2008.06.001
10.1016/j.avsg.2008.06.001
PubMed Web of Science® Google Scholar
17LeeWA, HuberTS, HirneiseCM, BerceliSA, SeegerJM Eligibility rates of ruptured and symptomatic AAA for endovascular repair. J Endovasc Ther (2002) 9(4): 436–44212223003 10.1583/1545-1550(2002)009<0436:ERORAS>2.0.CO;2
10.1177/152660280200900409
PubMed Web of Science® Google Scholar
18DimickJB, CowanJAJr, StanleyJC, HenkePK, PronovostPJ, UpchurchGRJr Surgeon specialty and provider volumes are related to outcome of intact abdominal aortic aneurysm repair in the United States. J Vasc Surg (2003) 38(4): 739–74414560223 10.1016/S0741-5214(03)00470-1
10.1016/S0741-5214(03)00470-1
PubMed Web of Science® Google Scholar
19Ten BoschJA, WilligendaelEM, van SambeekMR, de LoosER, PrinsMH, TeijinkJA EVAR suitability is not a predictor for early and midterm mortality after open ruptured AAA repair. Eur J Vasc Endovasc Surg (2011) 41(5): 647–65121333561 10.1016/j.ejvs.2011.01.005
10.1016/j.ejvs.2011.01.005
CAS PubMed Web of Science® Google Scholar
20PerrottS, PuckridgePJ, ForemanRK, RussellDA, SparkJI Anatomical suitability for endovascular AAA repair may affect outcomes following rupture. Eur J Vasc Endovasc Surg (2010) 40(2): 186–19020434374 10.1016/j.ejvs.2010.04.002
10.1016/j.ejvs.2010.04.002
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume38, Issue5

May 2014

Pages 1223-1226

Ruptured AAA: Suitability for Endovascular Repair is Associated with Lower Mortality Following Open Repair

Abstract

Objectives

Design

Methods

Results

Conclusions

Conflict of interest

Funding

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Ruptured AAA: Suitability for Endovascular Repair is Associated with Lower Mortality Following Open Repair

Abstract

Objectives

Design

Methods

Results

Conclusions

Conflict of interest

Funding

References

Citing Literature

References

Related

Information