Abstract Hypothesis: Endovascular aortic repair (EVAR) has been increasingly applied as a less invasive approach for treatment of ruptured abdominal aortic aneurysms (rAAA). Nevertheless, results are unclear and a number of patients with rAAA are deemed unfit for repair and excluded from any treatment. Objective of this study was to examine the impact on survival of EVAR and open surgery without palliation in acute AAA repair. Methods: Consecutive patients admitted for rAAA from 2006 to 2014 were reviewed. None of the patients were denied treatment. Rupture was defined according to Computed Tomography (CT) scan performed in emergency room (ER). Symptomatic non-ruptured AAAs were not included in this study. EVAR feasibility was left to the discretion of the operative specialized team available 24/7. Results: A total of 104 patients (87 males; mean age 77.3y, range 44.4y to 93.9y) with rAAA were treated in emergency: 63 underwent open surgery and 41 EVAR. Mean AAA diameter was 72.8mm in the EVAR and 82.3mm in the open group (P=0.07). At baseline there was an equal distribution of physiologic and hemodynamic characteristics and comorbidities with the exception of age, older in the EVAR group. Overall 30-day mortality rate was 35.6% (37/104): rates were 38.1% (24/63) and 31.7% (13/41) after open surgery and EVAR, respectively (OR 0.7; 95%CI 0.33-1.73;P=0.54). Almost half the patients (n=50) were octogenarians and were more often treated by EVAR (29/41 vs 21/63; P<0.0001). Perioperative mortality in octogenarians was 44.0%, with increased risks after open surgery (57.1% vs 34.5 % open surgery vs EVAR respectively; P=0.15) and was non-significantly higher when compared to younger patients (27.2%;P=0.10). Mean overall survival for patients treated for rAAA was 50.9 months without relevant difference after open surgery or EVAR (55.2 vs 43.6 months; P=0.23). Conclusions: In the current endovascular era the decision to palliate patients with rAAA may be revisited. Cohort studies also including patients deemed unfit for repair might provide more reliable information on how and when to best apply EVAR in acute AAA settings.
Palliation of Ruptured Abdominal Aortic Aneurysms May Not Be Justified in the Endovascular Era
Paola De Rango
Writing – Original Draft Preparation
;Gioele SimonteInvestigation
;Enrico CieriInvestigation
;Fabio VerziniConceptualization
2014
Abstract
Abstract Hypothesis: Endovascular aortic repair (EVAR) has been increasingly applied as a less invasive approach for treatment of ruptured abdominal aortic aneurysms (rAAA). Nevertheless, results are unclear and a number of patients with rAAA are deemed unfit for repair and excluded from any treatment. Objective of this study was to examine the impact on survival of EVAR and open surgery without palliation in acute AAA repair. Methods: Consecutive patients admitted for rAAA from 2006 to 2014 were reviewed. None of the patients were denied treatment. Rupture was defined according to Computed Tomography (CT) scan performed in emergency room (ER). Symptomatic non-ruptured AAAs were not included in this study. EVAR feasibility was left to the discretion of the operative specialized team available 24/7. Results: A total of 104 patients (87 males; mean age 77.3y, range 44.4y to 93.9y) with rAAA were treated in emergency: 63 underwent open surgery and 41 EVAR. Mean AAA diameter was 72.8mm in the EVAR and 82.3mm in the open group (P=0.07). At baseline there was an equal distribution of physiologic and hemodynamic characteristics and comorbidities with the exception of age, older in the EVAR group. Overall 30-day mortality rate was 35.6% (37/104): rates were 38.1% (24/63) and 31.7% (13/41) after open surgery and EVAR, respectively (OR 0.7; 95%CI 0.33-1.73;P=0.54). Almost half the patients (n=50) were octogenarians and were more often treated by EVAR (29/41 vs 21/63; P<0.0001). Perioperative mortality in octogenarians was 44.0%, with increased risks after open surgery (57.1% vs 34.5 % open surgery vs EVAR respectively; P=0.15) and was non-significantly higher when compared to younger patients (27.2%;P=0.10). Mean overall survival for patients treated for rAAA was 50.9 months without relevant difference after open surgery or EVAR (55.2 vs 43.6 months; P=0.23). Conclusions: In the current endovascular era the decision to palliate patients with rAAA may be revisited. Cohort studies also including patients deemed unfit for repair might provide more reliable information on how and when to best apply EVAR in acute AAA settings.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
