Anatomical Suitability For Endovascular AAA Repair May Affect Outcomes following Rupture

Single centre series have suggested that endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) may reduce mortality versus open surgery. This has not been substantiated in the only randomized controlled trial, leading to suggestion that anatomical suitability for rEVAR may independently improve prognosis of rAAA. Our aim was to assess the outcome of open rAAA repair in patients dependant on their suitability for rEVAR on pre-operative computed tomography (CT) assessment. Methods: A retrospective review of all ruptured aneurysms presenting to our unit since January 1998 was performed. Patients were grouped based on anatomical suitability for rEVAR by pre-operative CT. Results: Of 118 patients presenting with rAAA, 48 underwent pre-operative CT. Of these 9 scans had been "culled" and were excluded. 16 patients were suitable for rEVAR and 23 unsuitable. The groups were well matched demographically with no difference in Glasgow Aneurysm Score between groups. There was a non-significant trend towards reduction in 30-day mortality for patients suitable for EVAR (suitable 6.9% versus unsuitable 30.4%; P = 0.066) with no difference in operative time, transfusion requirement, length of stay or in-hospital morbidity. Conclusions: Anatomical suitability for EVAR seems to beneficially affect outcome following open repair for ruptured AAA. Further study is required to confirm these findings. Crown Copyright (C) 2010 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. All rights reserved.