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

To investigate whether endovascular repair of ruptured abdominal aortic aneurysm (RAAA), performed whenever anatomically feasible, would be superior in a real-world registry.

Retrospective analysis of consecutive RAAA patients treated at the emergency department of a single hospital from January 2011 to December 2023, after implementation of protocol-based care. The variables of interest were hemodynamic stability, proximal neck length, and type of intervention. The outcomes were 30-day mortality and long-term survival. Statistical analyses were conducted using the chi-square test, Student's t-test, and Pearson correlation. Logistic regression was used to construct a propensity score for matching, and survival rates were illustrated using Kaplan-Meier curves.

Among 209 treated patients, anatomical location included infrarenal, isolated iliac, and juxta-renal aneurysms. Endovascular repair was performed in 121 patients (57.9%), with a significant difference in proximal neck length compared to the open repair group (median 19.7 mm vs. 7.9 mm, P < 0.001). Hemodynamic instability was present in 39% at admission. The overall 30-day mortality rate was 44%; endovascular repair was associated with lower mortality (34.7%, P = 0.001, 95% confidence interval: 0.263-0.431) before matching. Factors such as kidney failure, hemodynamic stability, proximal neck length, and morphology were significantly associated with mortality outcomes. However, propensity score matching (PSM, 42 pairs) revealed no statistical superiority of either technique.

While initial analysis indicated lower 30-day mortality in the endovascular group, PSM revealed no significant difference in either 30-day or long-term mortality between endovascular and open repair when anatomically feasible. Intervention choices should be tailored based on individual anatomical circumstances, the expertise of the medical team, and the resources at hand. Our propensity score analysis was the first to consider anatomical features; nevertheless, endovascular repair demonstrated no clear superiority to open repair.