A Study Comparing the Outcomes of Ruptured Post-EVAR Aneurysms with Those Occurring Without Previous Treatment

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Research
• Endovascular Interventions

Background:

• Endovascular Aortic Repair (EVAR) is increasingly used for Abdominal Aortic Aneurysm (AAA), but rupture remains a critical complication.
• Rupture post-EVAR occurs in 1-5% of treated patients, posing a significant threat.
• Comparing outcomes of ruptured EVAR (rEVAR) versus no prior intervention (rWPT) is crucial for understanding AAA rupture management.

Purpose of the Study:

• To compare patient characteristics, hemodynamic status, and outcomes between ruptured AAA patients with prior EVAR and those without.
• To identify prognostic factors for mortality in patients presenting with AAA rupture.

Main Methods:

• Analysis of prospectively recorded data from the HEVAR Registry (January 2019 - November 2023).
• Inclusion of consecutive patients with ruptured infrarenal/juxtarenal AAA undergoing endovascular or open repair.
• Comparison of two groups: patients with previous EVAR (rEVAR) and those with no previous aortic intervention (rWPT).

Main Results:

• A total of 203 AAA rupture patients were studied; 19.7% had prior EVAR.
• No significant difference in hemodynamic status at presentation between rEVAR and rWPT groups.
• Overall mortality was 40.4%; rEVAR mortality (37.5%) was not significantly different from rWPT (41.1%).
• Age, hemodynamic shock, and open repair were significant predictors of mortality.

Conclusions:

• Post-EVAR AAA rupture patients exhibit similar hemodynamic instability as de novo rupture patients.
• Mortality for ruptured AAA post-EVAR is high and comparable to de novo ruptures.
• Age, initial hemodynamic shock, and undergoing open repair are critical risk factors for mortality in AAA rupture.