Early And Midterm Results Of Ruptured AAA In The Endovascular Era In A Community Hospital

Objectives: Endovascular repair(EVAR) have been increasingly used for ruptured abdominal aortic aneurysms(rAAA), especially in major academic centers. The goal of this paper is to report our results with EVAR-first approach for rAAA which we adopted since 2001 in our community hospital.
Methods: All consecutive patients with who underwent attempted repair for rAAA between 02/2001-07/2006 were analyzed. Only patients with CT/visual verification of extraluminal blood were included.
Results: Thirty-one patients (23/males,mean age 78(51-89)) underwent attempted EVAR for rAAA, constituting 4.2% of all EVAR cases(738). Eighteen(58%) were transferred from another institution. CT was performed in 96%. On arrival to ER, 39% were hypotensive(SBP<80mmHg). Balloon occlusion(BO) was used in 10 (transfemoral). AneuRx(22), Zenith(5) and Ancure(3) grafts were used(93%,bifurcated). Length of surgery was 144(77-230) minutes. EVAR was completed in 94% (iliac anatomy, proximal endoleak caused open conversion in 2). Five patients(16%) died within 30 days (4 required BO). Mean length-of-stay was 9.5(5-30) days. Two patients died (7,9months,unrelated) and 6(23%) required secondary procedures (5 femorofemoral bypasses for limb occlusions, one proximal cuff for type-I endoleak causing repeat rupture) during a mean follow-up of 16(3-39) months. Mortality was 44%(4/9) in patients who underwent open procedures during this period, with overall mortality of 22.5% for all ruptures treated.
Conclusions: Our results show that EVAR is feasible with favorable outcomes in patients presenting with rAAA in a busy community hospital. There is a high secondary intervention rate, which can potentially be decreased by ensuring good iliac limb anatomy at the end of the procedure and a closer follow-up.