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Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair.
J Vasc Surg. 2013 Feb; 57(2):368-75.JV

Abstract

OBJECTIVE

Endovascular aneurysm repair (EVAR) decreases 30-day mortality for patients with ruptured abdominal aortic aneurysms (r-AAAs) compared with open surgical repair (OSR). However, which patients benefit or whether there is any long-term survival advantage is uncertain.

METHODS

From 2002 to 2011, 283 patients with r-AAA underwent EVAR (n = 120 [42.4%]) or OSR (n = 163 [57.6%]) at Albany Medical Center. All data were collected prospectively. Patients were analyzed on an intention-to-treat basis, and outcomes were evaluated by a logistic regression multivariable model. Kaplan-Meier analysis was used to compare long-term survival.

RESULTS

The EVAR patients had a significantly lower 30-day mortality than did the OSR patients (29/120 [24.2%] vs 72/163 [44.2%]; P < .005) and better cumulative 5-year survival (37% vs 26%; P < .005). Men benefited more from EVAR (mortality: 20.9% for EVAR vs 44.3% for OSR; P < .001) than did women (mortality: 32.4% vs 43.9%; P = .39). Age ≥80 years was a significant predictor of death for EVAR (odds ratio [OR], 1.07; P = .003) but not for OSR (OR, 1.04; P = .056). Preexisting hypertension was a significant predictor of survival for both EVAR (OR, 0.17; P < .001) and OSR (OR, 0.48; P = .021). Almost one fourth of EVAR patients (21/91 [23.1%]) required secondary interventions. Survival advantage was maintained for EVAR patients to 5 years.

CONCLUSIONS

For r-AAA, EVAR reduces the 30-day mortality and improves long-term survival up to 5 years. However, whereas open survivors require few graft-related interventions, up to 23% of EVAR patients will require reintervention for endoleaks or graft migration. Close follow-up of all EVAR survivors is mandatory.

Authors+Show Affiliations

Center for Vascular Awareness, Inc, Vascular Group PLLC, Albany Medical College, Albany Medical Center, Albany, NY 12208, USA. mehtam@albanyvascular.comNo 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

23265582

Citation

Mehta, Manish, et al. "Endovascular Repair of Ruptured Infrarenal Abdominal Aortic Aneurysm Is Associated With Lower 30-day Mortality and Better 5-year Survival Rates Than Open Surgical Repair." Journal of Vascular Surgery, vol. 57, no. 2, 2013, pp. 368-75.
Mehta M, Byrne J, Darling RC, et al. Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair. J Vasc Surg. 2013;57(2):368-75.
Mehta, M., Byrne, J., Darling, R. C., Paty, P. S., Roddy, S. P., Kreienberg, P. B., Taggert, J. B., & Feustel, P. (2013). Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair. Journal of Vascular Surgery, 57(2), 368-75. https://doi.org/10.1016/j.jvs.2012.09.003
Mehta M, et al. Endovascular Repair of Ruptured Infrarenal Abdominal Aortic Aneurysm Is Associated With Lower 30-day Mortality and Better 5-year Survival Rates Than Open Surgical Repair. J Vasc Surg. 2013;57(2):368-75. PubMed PMID: 23265582.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular repair of ruptured infrarenal abdominal aortic aneurysm is associated with lower 30-day mortality and better 5-year survival rates than open surgical repair. AU - Mehta,Manish, AU - Byrne,John, AU - Darling,R Clement,3rd AU - Paty,Philip S K, AU - Roddy,Sean P, AU - Kreienberg,Paul B, AU - Taggert,John B, AU - Feustel,Paul, Y1 - 2012/12/21/ PY - 2012/05/14/received PY - 2012/09/13/revised PY - 2012/08/13/accepted PY - 2012/12/26/entrez PY - 2012/12/26/pubmed PY - 2013/3/15/medline SP - 368 EP - 75 JF - Journal of vascular surgery JO - J Vasc Surg VL - 57 IS - 2 N2 - OBJECTIVE: Endovascular aneurysm repair (EVAR) decreases 30-day mortality for patients with ruptured abdominal aortic aneurysms (r-AAAs) compared with open surgical repair (OSR). However, which patients benefit or whether there is any long-term survival advantage is uncertain. METHODS: From 2002 to 2011, 283 patients with r-AAA underwent EVAR (n = 120 [42.4%]) or OSR (n = 163 [57.6%]) at Albany Medical Center. All data were collected prospectively. Patients were analyzed on an intention-to-treat basis, and outcomes were evaluated by a logistic regression multivariable model. Kaplan-Meier analysis was used to compare long-term survival. RESULTS: The EVAR patients had a significantly lower 30-day mortality than did the OSR patients (29/120 [24.2%] vs 72/163 [44.2%]; P < .005) and better cumulative 5-year survival (37% vs 26%; P < .005). Men benefited more from EVAR (mortality: 20.9% for EVAR vs 44.3% for OSR; P < .001) than did women (mortality: 32.4% vs 43.9%; P = .39). Age ≥80 years was a significant predictor of death for EVAR (odds ratio [OR], 1.07; P = .003) but not for OSR (OR, 1.04; P = .056). Preexisting hypertension was a significant predictor of survival for both EVAR (OR, 0.17; P < .001) and OSR (OR, 0.48; P = .021). Almost one fourth of EVAR patients (21/91 [23.1%]) required secondary interventions. Survival advantage was maintained for EVAR patients to 5 years. CONCLUSIONS: For r-AAA, EVAR reduces the 30-day mortality and improves long-term survival up to 5 years. However, whereas open survivors require few graft-related interventions, up to 23% of EVAR patients will require reintervention for endoleaks or graft migration. Close follow-up of all EVAR survivors is mandatory. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/23265582/Endovascular_repair_of_ruptured_infrarenal_abdominal_aortic_aneurysm_is_associated_with_lower_30_day_mortality_and_better_5_year_survival_rates_than_open_surgical_repair_ DB - PRIME DP - Unbound Medicine ER -