Print this pageRuptured Abdominal Aortic Aneurysms: Endovascular Versus Open Repair
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Abstract 04
Manish Mehta, MD, R. Clement Darling, III, MD, Sean P. Roddy, MD, Philip S.K. Paty, MD, Kathleen J. Ozsvath, MD, Paul B. Kreienberg, MD, Benjamin B. Chang, MD, Dhiraj M. Shah, MD.
Albany Medical College, Albany, NY, USA.
Purpose: Despite improvements in perioperative diagnosis, treatment, and postoperative ICU care, emergent repair of ruptured abdominal aortic aneurysms (rAAA) remains associated with a high perioperative morbidity and mortality over the past four decades. In this report, we compare our results of endovascular repair of rAAA to a similar group of patients who have undergone open repair for rAAA.
Methods: From January 2002 to July 2004, 68 patients presented to our institution with rAAA and all underwent repir via endovascular or open surgical approach. This was a non-randomized group and patients were selected for endovascular versus open surgical repair by physician preference and not by patient condition at presentation. Data was prospectively collected in the vascular registry and analyzed.
Results: Over a 2-½ year period, 68 rAAA were treated by endovascular (n=29, 43%) or open surgical (n=39, 57%) approach. The endovascular group had higher preexisting comorbidities of CAD (70% vs 44%), HTN (75% vs 47%), and COPD (30% vs 9%) when compared to the open surgical group.
| Endo | Open | |
| N | 29 | 39 |
| Hemodynamically Unstable | 8 (28%) | 12 (31%) |
| EBL | 580 (100-2000) | 2937 (500-7000) |
| MI | 2 (7%) | 8 (21%) |
| IC | 2 (7%) | 6 (15%) |
| ACS | 6 (21%) | 0 |
| MSOF | 0 | 1 (3%) |
| Death | 8 (28%) | 20 (51%) |
EBL: Estimated Blood Loss, MI: Myocardial Infarction, IC: Ischemic Colitis, ACS: Abdominal Compartment Syndrome, MSOF: Multisystem Organ Failure
Conclusion: Ruptured AAA can be repaired with less mortality using the endovascular technique in an institution that is comfortable with this procedure. The mortality when compared to an open operation is significantly less, however, the morbidity of both groups was similar due to the universal risk of abdominal compartment syndrome in the endovascular patient. The establishment of an endovascular program is mandatory before the procedure should be undertaken, however, early results look promising.