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Long-term Outcomes Following Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms
Aurélien M Guéroult1, Farhaan A Khan1, Philip W Stather1
1Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, Cambridge, UK.
Summary
Endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) shows acceptable short-term survival but requires lifelong monitoring due to high reintervention rates. Long-term outcomes indicate significant reintervention needs post-emergency EVAR.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Aortic Aneurysm Management
Background:
- Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening emergency.
- Endovascular aneurysm repair (EVAR) has emerged as an alternative to open repair for rAAA.
- Long-term outcomes and reintervention rates following emergency EVAR for rAAA require further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA).
- To assess mortality and reintervention rates in patients undergoing EVAR for rAAA over an 11-year period.
Main Methods:
- Retrospective analysis of 121 patients with rAAA treated with emergency EVAR.
- Inclusion criteria: confirmed hematoma on preoperative CT, aortic or iliac artery rupture.
- Primary outcomes: mortality and reintervention rates; Kaplan-Meier estimates used for survival and freedom from reintervention.
Main Results:
- In-hospital and 30-day mortality were 16.5%; 90-day mortality was 24.0%.
- Five-year mortality was 61.7%.
- 30.6% of patients required reintervention, with a median time to first reintervention of 3.2 years; 5-year freedom from reintervention was 51% in survivors.
Conclusions:
- Emergency EVAR for rAAA offers acceptable short-term results.
- Long-term surveillance is crucial due to a high incidence of reinterventions.
- Reintervention is a common necessity following EVAR for ruptured abdominal aortic aneurysms.
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