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Short-term and midterm survival of ruptured abdominal aortic aneurysms in the contemporary endovascular era.
J Vasc Surg. 2018 08; 68(2):408-414.e1.JV

Abstract

OBJECTIVE

Endovascular aneurysm repair (EVAR) has been shown to reduce mortality in the emergent repair of ruptured abdominal aortic aneurysms (AAAs). However, long-term survival data for this group of patients are lacking with contemporary endovascular endografts. The purpose of this study was to evaluate both 30-day mortality rates and 1-year survival in patients undergoing emergent EVAR in a 43-facility hospital system with a quaternary referral center with an established ruptured aneurysm protocol.

METHODS

Retrospective analysis of patients captured prospectively in an Institutional Review Board-approved registry for patients treated emergently for AAA were reviewed between 2012 and 2017 was conducted. Primary outcome measures were 30-day mortality and 1-year survival for the entire group as well as for symptomatic and ruptured aneurysms. Data were analyzed using logistic regression survival curves, and a log-rank test was performed to compare survival between open and endovascular repair. Patients were evaluated on an intent-to-treat basis, and outcomes were evaluated in a multivariate model.

RESULTS

A total of 249 patients were referred as part of the protocol. Of these, 102 (41%) were treated emergently. Kaplan-Meier estimates of 30-day and 1-year survival were 64% and 53% for all patients, 58% and 46% for ruptured patients, and 86% and 81% for symptomatic patients. EVAR resulted in improved 30-day survival (64% vs 31%; odds ratio, 4.0; P = .03) and 1-year survival (40% vs 23%; odds ratio, 2.3; P = .4) over open repair. Significant predictors for 30-day mortality included hypotension (P = .0003), blood transfusion (P < .0001), length of stay (P = .0005), extravasation (P = .01), preoperative cardiopulmonary resuscitation (P = .04), open repair (P = .007), aortouni-iliac reconstruction (P = .008), and abdominal compartment syndrome (P = .007). Significant predictors for 1-year mortality included advanced age (P = .04), hypotension (P = .01), blood transfusion (P = .006), extravasation (P = .03), reintubation (P = .03), and abdominal compartment syndrome (P = .03). There were no differences in outcomes based on race, gender, or outside transfer. Peripheral arterial disease (P = .04), hypertension (P = .04), coronary artery disease (P = .03), and familial history of aneurysms (P = .05) were related to increased 30-day mortality. Peripheral arterial disease (P = .06) and coronary artery disease (P = .07) were nearly significant, with increased 1-year mortality.

CONCLUSIONS

EVAR is associated with improved survival compared with open repair in patients requiring emergent AAA repair. However, in the first year, there is a significant risk of death based on initial presentation as well as underlying comorbidities. To improve long-term survival, aggressive medical management and medical surveillance are warranted.

Authors+Show Affiliations

Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC.Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC.Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC.Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC.Carolinas Medical Center for Outcomes Research and Evaluation, Charlotte, NC.Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC.Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC.Carolinas Medical Center, Sanger Heart and Vascular Institute, Charlotte, NC. Electronic address: farkomd@gmail.com.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29526377

Citation

Briggs, Charles S., et al. "Short-term and Midterm Survival of Ruptured Abdominal Aortic Aneurysms in the Contemporary Endovascular Era." Journal of Vascular Surgery, vol. 68, no. 2, 2018, pp. 408-414.e1.
Briggs CS, Sibille JA, Yammine H, et al. Short-term and midterm survival of ruptured abdominal aortic aneurysms in the contemporary endovascular era. J Vasc Surg. 2018;68(2):408-414.e1.
Briggs, C. S., Sibille, J. A., Yammine, H., Ballast, J. K., Anderson, W., Nussbaum, T., Roush, T. S., & Arko, F. R. (2018). Short-term and midterm survival of ruptured abdominal aortic aneurysms in the contemporary endovascular era. Journal of Vascular Surgery, 68(2), 408-e1. https://doi.org/10.1016/j.jvs.2017.12.037
Briggs CS, et al. Short-term and Midterm Survival of Ruptured Abdominal Aortic Aneurysms in the Contemporary Endovascular Era. J Vasc Surg. 2018;68(2):408-414.e1. PubMed PMID: 29526377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short-term and midterm survival of ruptured abdominal aortic aneurysms in the contemporary endovascular era. AU - Briggs,Charles S, AU - Sibille,Joshua A, AU - Yammine,Halim, AU - Ballast,Jocelyn K, AU - Anderson,William, AU - Nussbaum,Tzvi, AU - Roush,Timothy S, AU - Arko,Frank R,3rd Y1 - 2018/03/08/ PY - 2017/09/13/received PY - 2017/12/09/accepted PY - 2018/3/13/pubmed PY - 2018/7/31/medline PY - 2018/3/13/entrez SP - 408 EP - 414.e1 JF - Journal of vascular surgery JO - J Vasc Surg VL - 68 IS - 2 N2 - OBJECTIVE: Endovascular aneurysm repair (EVAR) has been shown to reduce mortality in the emergent repair of ruptured abdominal aortic aneurysms (AAAs). However, long-term survival data for this group of patients are lacking with contemporary endovascular endografts. The purpose of this study was to evaluate both 30-day mortality rates and 1-year survival in patients undergoing emergent EVAR in a 43-facility hospital system with a quaternary referral center with an established ruptured aneurysm protocol. METHODS: Retrospective analysis of patients captured prospectively in an Institutional Review Board-approved registry for patients treated emergently for AAA were reviewed between 2012 and 2017 was conducted. Primary outcome measures were 30-day mortality and 1-year survival for the entire group as well as for symptomatic and ruptured aneurysms. Data were analyzed using logistic regression survival curves, and a log-rank test was performed to compare survival between open and endovascular repair. Patients were evaluated on an intent-to-treat basis, and outcomes were evaluated in a multivariate model. RESULTS: A total of 249 patients were referred as part of the protocol. Of these, 102 (41%) were treated emergently. Kaplan-Meier estimates of 30-day and 1-year survival were 64% and 53% for all patients, 58% and 46% for ruptured patients, and 86% and 81% for symptomatic patients. EVAR resulted in improved 30-day survival (64% vs 31%; odds ratio, 4.0; P = .03) and 1-year survival (40% vs 23%; odds ratio, 2.3; P = .4) over open repair. Significant predictors for 30-day mortality included hypotension (P = .0003), blood transfusion (P < .0001), length of stay (P = .0005), extravasation (P = .01), preoperative cardiopulmonary resuscitation (P = .04), open repair (P = .007), aortouni-iliac reconstruction (P = .008), and abdominal compartment syndrome (P = .007). Significant predictors for 1-year mortality included advanced age (P = .04), hypotension (P = .01), blood transfusion (P = .006), extravasation (P = .03), reintubation (P = .03), and abdominal compartment syndrome (P = .03). There were no differences in outcomes based on race, gender, or outside transfer. Peripheral arterial disease (P = .04), hypertension (P = .04), coronary artery disease (P = .03), and familial history of aneurysms (P = .05) were related to increased 30-day mortality. Peripheral arterial disease (P = .06) and coronary artery disease (P = .07) were nearly significant, with increased 1-year mortality. CONCLUSIONS: EVAR is associated with improved survival compared with open repair in patients requiring emergent AAA repair. However, in the first year, there is a significant risk of death based on initial presentation as well as underlying comorbidities. To improve long-term survival, aggressive medical management and medical surveillance are warranted. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/29526377/Short_term_and_midterm_survival_of_ruptured_abdominal_aortic_aneurysms_in_the_contemporary_endovascular_era_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)30145-9 DB - PRIME DP - Unbound Medicine ER -