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

Although endovascular aortic repair (EVAR) has been increasingly used for the treatment of abdominal aortic aneurysm (AAA), rupture is still a life-threatening event in 1-5% of those treated patients. We aimed to compare the characteristics, hemodynamic status at presentation, and outcomes between patients with previous EVAR (ruptured EVAR [rEVAR]) and those with no previous aortic intervention (rWPT group) who presented with AAA rupture.

Between January 2019 and November 2023, all consecutive patients who experienced a ruptured infrarenal/juxtarenal AAA, received endovascular or open intervention and prospectively recorded in the Hellenic Vascular Registry (Greek) were analyzed. The two groups of patients (rEVAR and rWPT) were compared.

A total of 203 patients with AAA rupture were studied. Among them, 40 patients (19.7%) had previous EVAR for AAA (rEVAR group), while the remaining (163; 80.3%) were included in the rWPT group. Patients with rEVAR were on average 5.8 years significantly older (P < 0.001). There was no significant difference regarding the hemodynamic status at presentation between rEVAR and rWPT groups. The overall mortality was 40.4% (82/203). Mortality for patients with rEVAR was 37.5% compared to 41.1% for the group of rWPT (P = 0.7). Among all patients, age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.04-1.12; P < 0.001), hemodynamic shock at initial presentation (OR: 6.57, 95% CI: 2.52-17.12; P < 0.001), and open repair (OR: 5.31, 95% CI: (2.33-12.08; P < 0.001) were significant prognostic factors of mortality.

Our study provides evidence that patients with post-EVAR rupture are equally hemodynamically unstable at presentation compared to patients with de novo ruptures. The mortality associated with post-EVAR rupture is high and not inferior compared to that observed for de novo ruptures. Significant risk factors for a dismal outcome in the whole cohort of patients who presented with AAA rupture were age, hemodynamic shock at initial presentation, and open repair.