Endovascular Treatment Protocol for Ruptured Abdominal Aortic Aneurysm: Ten-Year Experience

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Public Health

Background:

• Ruptured abdominal aortic aneurysm (RAAA) presents a critical surgical emergency.
• Endovascular repair is increasingly utilized for RAAA when anatomically feasible.
• Real-world data is crucial to evaluate the comparative effectiveness of endovascular versus open repair for RAAA.

Purpose of the Study:

• To compare the effectiveness of endovascular repair versus open repair for RAAA in a real-world setting.
• To assess the impact of anatomical feasibility on treatment outcomes for RAAA.
• To evaluate 30-day and long-term survival rates following different repair strategies for RAAA.

Main Methods:

• Retrospective analysis of 209 consecutive RAAA patients treated between 2011 and 2023.
• Comparison of endovascular repair (n=121) versus open repair (n=88) based on hemodynamic stability, neck length, and intervention type.
• Propensity score matching (42 pairs) was used to control for baseline differences; Kaplan-Meier curves illustrated survival rates.

Main Results:

• Initial analysis showed lower 30-day mortality for endovascular repair (34.7%) versus open repair (44%).
• Significant differences were observed in proximal neck length between endovascular and open repair groups.
• Propensity score matching revealed no statistically significant difference in 30-day or long-term mortality between the two repair methods.

Conclusions:

• Endovascular repair did not demonstrate clear superiority over open repair for RAAA, even when anatomically feasible, after propensity score matching.
• Treatment decisions for RAAA should consider individual patient anatomy, surgeon expertise, and available resources.
• This study highlights the importance of robust statistical methods like PSM in evaluating real-world treatment outcomes for complex vascular emergencies.