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Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm
S C van Beek1, A Vahl2, W Wisselink3
1Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Summary
Endovascular repair (EVAR) and open repair (OR) for ruptured abdominal aortic aneurysms (RAAA) showed similar midterm re-intervention and survival rates. However, EVAR had a higher re-intervention rate in patients surviving initial hospital stay.
Area of Science:
- Vascular Surgery
- Aortic Aneurysm Repair
- Interventional Cardiology
Background:
- Ruptured abdominal aortic aneurysms (RAAA) are a critical surgical emergency.
- Endovascular Aneurysm Repair (EVAR) and Open Repair (OR) are primary treatment modalities.
- Midterm outcomes comparing EVAR and OR for RAAA require further investigation.
Purpose of the Study:
- To compare midterm re-intervention and survival rates between EVAR and OR for RAAA.
- To analyze re-intervention rates in patients surviving their initial hospital stay.
- To adjust for confounders influencing re-intervention and survival.
Main Methods:
- Observational cohort study of 467 RAAA patients (2004-2011).
- Primary endpoint: re-interventions within 5 years; Secondary endpoint: death.
- Survival analyses, logrank test, and Cox proportional hazard models were used for outcome estimation and adjustment.
Main Results:
- Five-year freedom from re-intervention rates were similar: 55% for EVAR vs. 60% for OR (p=0.96).
- Five-year survival rates were similar: 36% for EVAR vs. 38% for OR (p=0.83).
- In hospital survivors, re-intervention rates were higher for EVAR (66%) than OR (90%) (p<0.01).
Conclusions:
- EVAR and OR demonstrate comparable midterm re-intervention and survival rates for RAAA.
- Patients undergoing EVAR who survive their hospital stay face a higher risk of re-intervention compared to OR.
- These findings highlight the importance of considering post-discharge outcomes in RAAA treatment selection.
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