Real world short and mid-term outcomes of EVAR and open repair of ruptured AAA in the post-IMPROVE era

Abstract

• Objectives:

We aimed to study the real-world outcomes of EVAR and open repair (OSR) of ruptured AAA to further clarify the optimal management strategy for this difficult cohort.

• Methods:

We studied short term (30 day) and mid-term (2 year) outcomes of 120 patients with ruptured AAA who underwent EVAR(n=60) or OSR(n=60) between June 2015 – November 2021 in terms of technical aspects, 30-day all cause mortality rates, mid-term survival rates (up to 24 months) and post-operative complication rates (peri-operative and mid-term). Data was analyzed using IBM SPSS version 20.0. (Armonk, NY: IBM Corp).

• Results:

Successful aortic repair was achieved in 90% of OSR cases, the majority of these being tube graft repairs (81.5%) vs 98% of EVAR cases. The 30-day all-cause mortality was significantly higher in the OSR group (38.3%) compared to the EVAR group (13.3%). At 2 year followup, 2 and 3 further deaths were reported in OSR and EVAR groups, respectively. No significant differences were found in terms of cardiovascular, respiratory or renal complications between both groups. However, significantly higher renal complications were noted in cases requiring suprarenal clamping in OSR and significantly higher mortality was noted in cases requiring aortic occlusion balloons in EVAR. Length of ICU stay was significantly shorter with EVAR, but total hospital stay was not.

• Conclusions:

Our study shows that EVAR for ruptured AAA, when anatomically suitable, offers a significant survival benefit in the short and medium-term, especially if done under local anesthetic.

Furthermore, in patients who are not anatomically suitable for EVAR and who receive an open surgical repair, all efforts should be made to use an infrarenal clamp site.

Despite the advances in peri-operative and ICU care, mortality rates for open repair of ruptured AAA have remained consistently high.