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Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms.
Ann Vasc Surg. 2011 May; 25(4):461-8.AV

Abstract

BACKGROUND

The continued success of elective endovascular aneurysm repair (EVAR) has led to an extension of this technology to ruptured aortas. The purpose of this study was to evaluate our results of ruptured infrarenal aortic aneurysm (rAAA).

METHODS

The treatment results of all patients who underwent repair of rAAAs between January 1990 and May 2008 were reviewed retrospectively. Comorbidities, intraoperative details, and postoperative complications were tabulated. EVAR and open repair were compared.

RESULTS

Between January 1990 and May 2008, 160 patients underwent repair of rAAA. Of these, 32 (20%) underwent EVAR for rAAA; of 160 patients, 112 were considered to have free rupture (70%) and 48 had contained rupture (30%). The average Acute Physiology and Chronic Health Evaluation II score was 13.3 ± 6.7. The Kaplan-Meier survival rates at 30 days, 6 months, 1 year, and 5 years were 69% (62,77), 57% (50,65), 50% (43,59), and 25% (19,34), respectively, with no difference seen in EVAR group as compared with open surgery (p = 0.24). Intraoperative mortality was 5.6%, with no patient undergoing EVAR suffering an intraoperative death (p = 0.03). However, 30-day mortality was 31.9% with no difference between EVAR and open surgery (31.2% vs. 32%; p = 0.93) results. Multivariate analysis for 30-day mortality found renal insufficiency (RI) odds ratio (OR): 2.4 (1.1, 5.3), p = 0.04; hypotension OR: 2.4 (1.1, 5.3), p = 0.02; and cardiac arrest OR: 3.8 (1.1, 11.6, p = 0.03), were all associated with the greatest mortality. Of all predictors analyzed, multivariate analysis found preoperative RI OR: 2.32 (1.55, 3.47), p < 0.001, was the only independent predictor of decreased long-term survival.

CONCLUSIONS

Mortality rates for rAAA remain high. The use of EVAR for these procedures equals that for open repair with regard to 30-day and long-term mortality. Preoperative cardiac arrest and RI were associated with inferior results for both EVAR and open repair. Clinical judgment on when to use EVAR as a primary repair modality must be exercised.

Authors+Show Affiliations

Department of Vascular Surgery, Cleveland Clinic Lerner School of Medicine, Cleveland Clinic, Cleveland, OH, USA. saract@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

21549913

Citation

Sarac, Timur P., et al. "Comparative Predictors of Mortality for Endovascular and Open Repair of Ruptured Infrarenal Abdominal Aortic Aneurysms." Annals of Vascular Surgery, vol. 25, no. 4, 2011, pp. 461-8.
Sarac TP, Bannazadeh M, Rowan AF, et al. Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms. Ann Vasc Surg. 2011;25(4):461-8.
Sarac, T. P., Bannazadeh, M., Rowan, A. F., Bena, J., Srivastava, S., Eagleton, M., Lyden, S., Clair, D. G., & Kashyap, V. (2011). Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms. Annals of Vascular Surgery, 25(4), 461-8. https://doi.org/10.1016/j.avsg.2010.12.030
Sarac TP, et al. Comparative Predictors of Mortality for Endovascular and Open Repair of Ruptured Infrarenal Abdominal Aortic Aneurysms. Ann Vasc Surg. 2011;25(4):461-8. PubMed PMID: 21549913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative predictors of mortality for endovascular and open repair of ruptured infrarenal abdominal aortic aneurysms. AU - Sarac,Timur P, AU - Bannazadeh,Mohsen, AU - Rowan,A F, AU - Bena,James, AU - Srivastava,Sunita, AU - Eagleton,Mathew, AU - Lyden,Sean, AU - Clair,Daniel G, AU - Kashyap,Vikram, PY - 2010/07/06/received PY - 2010/12/27/revised PY - 2010/12/29/accepted PY - 2011/5/10/entrez PY - 2011/5/10/pubmed PY - 2011/8/30/medline SP - 461 EP - 8 JF - Annals of vascular surgery JO - Ann Vasc Surg VL - 25 IS - 4 N2 - BACKGROUND: The continued success of elective endovascular aneurysm repair (EVAR) has led to an extension of this technology to ruptured aortas. The purpose of this study was to evaluate our results of ruptured infrarenal aortic aneurysm (rAAA). METHODS: The treatment results of all patients who underwent repair of rAAAs between January 1990 and May 2008 were reviewed retrospectively. Comorbidities, intraoperative details, and postoperative complications were tabulated. EVAR and open repair were compared. RESULTS: Between January 1990 and May 2008, 160 patients underwent repair of rAAA. Of these, 32 (20%) underwent EVAR for rAAA; of 160 patients, 112 were considered to have free rupture (70%) and 48 had contained rupture (30%). The average Acute Physiology and Chronic Health Evaluation II score was 13.3 ± 6.7. The Kaplan-Meier survival rates at 30 days, 6 months, 1 year, and 5 years were 69% (62,77), 57% (50,65), 50% (43,59), and 25% (19,34), respectively, with no difference seen in EVAR group as compared with open surgery (p = 0.24). Intraoperative mortality was 5.6%, with no patient undergoing EVAR suffering an intraoperative death (p = 0.03). However, 30-day mortality was 31.9% with no difference between EVAR and open surgery (31.2% vs. 32%; p = 0.93) results. Multivariate analysis for 30-day mortality found renal insufficiency (RI) odds ratio (OR): 2.4 (1.1, 5.3), p = 0.04; hypotension OR: 2.4 (1.1, 5.3), p = 0.02; and cardiac arrest OR: 3.8 (1.1, 11.6, p = 0.03), were all associated with the greatest mortality. Of all predictors analyzed, multivariate analysis found preoperative RI OR: 2.32 (1.55, 3.47), p < 0.001, was the only independent predictor of decreased long-term survival. CONCLUSIONS: Mortality rates for rAAA remain high. The use of EVAR for these procedures equals that for open repair with regard to 30-day and long-term mortality. Preoperative cardiac arrest and RI were associated with inferior results for both EVAR and open repair. Clinical judgment on when to use EVAR as a primary repair modality must be exercised. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/21549913/Comparative_predictors_of_mortality_for_endovascular_and_open_repair_of_ruptured_infrarenal_abdominal_aortic_aneurysms_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(11)00081-1 DB - PRIME DP - Unbound Medicine ER -