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Endovascular Versus Open Repair as Primary Strategy for Ruptured Abdominal Aortic Aneurysm: A National
K Gunnarsson1, A Wanhainen2, K Djavani Gidlund1
1Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
Summary
This study found no difference in survival after ruptured abdominal aortic aneurysm (rAAA) repair between centers prioritizing endovascular repair (EVAR) and those prioritizing open repair. Findings support previous randomized trials in a large population.
Area of Science:
- Vascular Surgery
- Aortic Aneurysm Repair
- Public Health
Background:
- Randomized trials show no peri-operative survival benefit for endovascular aneurysm repair (EVAR) over open repair for ruptured abdominal aortic aneurysms (rAAA).
- Previous research has not extensively evaluated primary repair strategy effects on survival in non-selected, population-based settings.
Purpose of the Study:
- To compare early and midterm survival rates following ruptured abdominal aortic aneurysm (rAAA) repair based on a center's primary surgical strategy.
- To assess the impact of prioritizing endovascular aneurysm repair (EVAR) versus open repair on patient outcomes in a real-world setting.
Main Methods:
- A Swedish national population-based study analyzed 1,304 ruptured abdominal aortic aneurysm (rAAA) repairs from 2008-2012.
- Centers were categorized by primary strategy: primary EVAR (pEVARc) or primary open repair (pORc).
- Peri-operative outcomes, midterm survival, and repair incidence were compared between pEVARc and pORc.
Main Results:
- No significant difference in 30-day, 1-year, or 2-year mortality was observed between pEVARc and pORc.
- Patients treated at pEVARc had higher referral rates and respiratory comorbidity but similar survival outcomes.
- Endovascular aneurysm repair (EVAR) was associated with lower 30-day mortality overall, but this did not translate to a difference in strategy-based survival.
Conclusions:
- A primary endovascular aneurysm repair (EVAR) strategy does not impact mortality compared to a primary open repair strategy for ruptured abdominal aortic aneurysms (rAAA).
- These findings in a national, population-based cohort corroborate the results of earlier randomized controlled trials.
- The study supports the established evidence regarding the comparable efficacy of EVAR and open repair strategies for rAAA.
