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In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair.
J Vasc Surg. 2015 Jun; 61(6):1399-407.JV

Abstract

OBJECTIVE

Previous studies have reported that endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) has lower postoperative mortality than open repair (OR). However, comparisons involved heterogeneous populations that lacked adjustment for preoperative risk. We hypothesize that for RAAA patients stratified by a validated measure of preoperative mortality risk, EVAR has a lower in-hospital mortality and morbidity than does OR.

METHODS

In-hospital mortality and morbidity after EVAR and OR of RAAA were compared in patients from the Vascular Quality Initiative (2003-2013) stratified by the validated Vascular Study Group of New England RAAA risk score into low-risk (score 0-1), medium-risk (score 2-3), and high-risk (score 4-6) groups.

RESULTS

Among 514 patients who underwent EVAR and 651 patients who underwent OR of RAAA, EVAR had lower in-hospital mortality (25% vs 33%, P = .001). In risk-stratified patients, EVAR trended toward a lower mortality in the low-risk group (n = 626; EVAR, 10% vs OR, 15%; P = .07), had a significantly lower mortality in the medium-risk group (n = 457; EVAR, 37% vs OR, 48%; P = .02), and no advantage in the high-risk group (n = 82; EVAR, 95% vs OR, 79%; P = .17). Across all risk groups, cardiac complications (EVAR, 29% vs OR, 38%; P = .001), respiratory complications (EVAR, 28% vs OR, 46%; P < .0001), renal insufficiency (EVAR, 24% vs OR, 38%; P < .0001), lower extremity ischemia (EVAR, 2.7% vs OR, 8.1%; P < .0001), and bowel ischemia (EVAR, 3.9% vs OR, 10%; P < .0001) were significantly lower after EVAR than after OR. Across all risk groups, median (interquartile range) intensive care unit length of stay (EVAR, 2 [1-5] days vs OR, 6 [3-13] days; P < .0001) and hospital length of stay (EVAR, 6 [4-12] days vs OR, 13 [8-22] days; P < .0001) were lower after EVAR.

CONCLUSIONS

This novel risk-stratified comparison using a national clinical database showed that EVAR of RAAA has a lower mortality and morbidity compared with OR in low-risk and medium-risk patients and that EVAR should be used to treat these patients when anatomically feasible. For RAAA patients at the highest preoperative risk, there is no benefit to using EVAR compared with OR.

Authors+Show Affiliations

Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Mass.Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass.Division of Vascular & Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: william.robinson@umassmemorial.org.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25752694

Citation

Ali, Mujtaba M., et al. "In Patients Stratified By Preoperative Risk, Endovascular Repair of Ruptured Abdominal Aortic Aneurysms Has a Lower In-hospital Mortality and Morbidity Than Open Repair." Journal of Vascular Surgery, vol. 61, no. 6, 2015, pp. 1399-407.
Ali MM, Flahive J, Schanzer A, et al. In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair. J Vasc Surg. 2015;61(6):1399-407.
Ali, M. M., Flahive, J., Schanzer, A., Simons, J. P., Aiello, F. A., Doucet, D. R., Messina, L. M., & Robinson, W. P. (2015). In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair. Journal of Vascular Surgery, 61(6), 1399-407. https://doi.org/10.1016/j.jvs.2015.01.042
Ali MM, et al. In Patients Stratified By Preoperative Risk, Endovascular Repair of Ruptured Abdominal Aortic Aneurysms Has a Lower In-hospital Mortality and Morbidity Than Open Repair. J Vasc Surg. 2015;61(6):1399-407. PubMed PMID: 25752694.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair. AU - Ali,Mujtaba M, AU - Flahive,Julie, AU - Schanzer,Andres, AU - Simons,Jessica P, AU - Aiello,Francesco A, AU - Doucet,Danielle R, AU - Messina,Louis M, AU - Robinson,William P, Y1 - 2015/03/07/ PY - 2014/09/12/received PY - 2015/01/21/accepted PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2015/8/4/medline SP - 1399 EP - 407 JF - Journal of vascular surgery JO - J Vasc Surg VL - 61 IS - 6 N2 - OBJECTIVE: Previous studies have reported that endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) has lower postoperative mortality than open repair (OR). However, comparisons involved heterogeneous populations that lacked adjustment for preoperative risk. We hypothesize that for RAAA patients stratified by a validated measure of preoperative mortality risk, EVAR has a lower in-hospital mortality and morbidity than does OR. METHODS: In-hospital mortality and morbidity after EVAR and OR of RAAA were compared in patients from the Vascular Quality Initiative (2003-2013) stratified by the validated Vascular Study Group of New England RAAA risk score into low-risk (score 0-1), medium-risk (score 2-3), and high-risk (score 4-6) groups. RESULTS: Among 514 patients who underwent EVAR and 651 patients who underwent OR of RAAA, EVAR had lower in-hospital mortality (25% vs 33%, P = .001). In risk-stratified patients, EVAR trended toward a lower mortality in the low-risk group (n = 626; EVAR, 10% vs OR, 15%; P = .07), had a significantly lower mortality in the medium-risk group (n = 457; EVAR, 37% vs OR, 48%; P = .02), and no advantage in the high-risk group (n = 82; EVAR, 95% vs OR, 79%; P = .17). Across all risk groups, cardiac complications (EVAR, 29% vs OR, 38%; P = .001), respiratory complications (EVAR, 28% vs OR, 46%; P < .0001), renal insufficiency (EVAR, 24% vs OR, 38%; P < .0001), lower extremity ischemia (EVAR, 2.7% vs OR, 8.1%; P < .0001), and bowel ischemia (EVAR, 3.9% vs OR, 10%; P < .0001) were significantly lower after EVAR than after OR. Across all risk groups, median (interquartile range) intensive care unit length of stay (EVAR, 2 [1-5] days vs OR, 6 [3-13] days; P < .0001) and hospital length of stay (EVAR, 6 [4-12] days vs OR, 13 [8-22] days; P < .0001) were lower after EVAR. CONCLUSIONS: This novel risk-stratified comparison using a national clinical database showed that EVAR of RAAA has a lower mortality and morbidity compared with OR in low-risk and medium-risk patients and that EVAR should be used to treat these patients when anatomically feasible. For RAAA patients at the highest preoperative risk, there is no benefit to using EVAR compared with OR. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/25752694/In_patients_stratified_by_preoperative_risk_endovascular_repair_of_ruptured_abdominal_aortic_aneurysms_has_a_lower_in_hospital_mortality_and_morbidity_than_open_repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(15)00152-4 DB - PRIME DP - Unbound Medicine ER -