A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair

Bown, Matthew J.; Sutton, Alex J.; Bell, P. R.; Sayers, R.D.

doi:10.1046/j.1365-2168.2002.02122.x

Cited by 499 publications

(350 citation statements)

References 121 publications

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“…[2][3][4][5] Describing the results from one such program, Mehta et al 2 were able to show an 18% mortality rate following EVAR with a 95% success rate for the procedure, which compares favorably to prior repairs in which mortality for RAAA has hovered at 40% to 50% for the past 4 decades. 9 Moreover, this and other small institutional studies may not be representative of the population at large. We therefore looked at the current outcomes of EVAR and open repair for RAAA within the National Surgical Quality Improvement Program (NSQIP), which is representative of community as well as academic medical centers.…”

Section: ¤ ¤mentioning

confidence: 99%

Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005–07

Giles

Pomposelli

Hamdan

et al. 2009

Journal of Endovascular Therapy

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Purpose: To compare endovascular (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysms (RAAA) in terms of preoperative hemodynamic status and comorbidities. Methods: The 2005 to 2007 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was interrogated to find all patients undergoing repair for RAAA. Of the 567 RAAA repairs identified, 121 (21%) were endovascular and 446 (79%) were open. Demographics, comorbidities, and preoperative hemodynamic status were compared by repair method. Results: Age, sex, and race were similar between repair cohorts. EVAR patients had greater incidences of recent myocardial infarction (7% versus 2%, p<0.05), revascularization or amputation for peripheral vascular disease (8% versus 3%, p<0.05), and cerebrovascular disease (22% versus 11%, p<0.01). Preoperative hemodynamic status was similar based on need for >4 units of blood (3% versus 6%, p=0.31), intubation (12% versus 17%, p=0.18), impaired sensorium (7% versus 11%, p=0.25), coma (4% versus 5%, p=0.65), acute renal failure (2% versus 2%, p=0.60), and ASA class 5 (29% versus 34%, p=0.29). Open repair was associated with greater operative time (3.3 versus 2.6 hours, p<0.01) and intraoperative blood transfusions (8 versus 2 units, p<0.001). Overall mortality was 33.5% (EVAR 24% versus OSR 36%; OR 1.8, 95% CI 1.1 to 2.8, p<0.05). After adjusting for preoperative comorbidities and all preoperative hemodynamic variables, mortality after open repair was greater than after EVAR (OR 1.9, 95% CI 1.1 to 3.2, p<0.05). Overall postoperative complications were greater after open repair (62% versus 47%, p<0.01). Graft failure requiring reintervention was higher after EVAR (4% versus 1%, p<0.05), while rates of return to the operating room for a major operation were similar (21% versus 24%, p=0.43). Conclusion: For RAAA within NSQIP hospitals in recent years, preoperative hemodynamic status was similar between EVAR and OSR, but EVAR patients had greater comorbidities. Despite this and after accounting for minor differences in hemodynamic status, EVAR mortality was lower than OSR mortality. Institutions with adequate experience and resources should attempt endovascular repair for RAAA when anatomy allows.

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Section: ¤ ¤mentioning

confidence: 99%

Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005–07

Giles

Pomposelli

Hamdan

et al. 2009

Journal of Endovascular Therapy

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“…Overall mortality for ruptured AAA remains at~75%, with half the patients never reaching hospital and nearly half of those that do reach hospital dying as a result. However, as a result of improvements in surgical technique, peri-operative anaesthetic management and postoperative intensive therapy over the last 50 years, there have been modest improvements in 30-day postoperative patient survival of approximately 2.5% per decade [16].…”

Section: Emergency Abdominal Aortic Aneurysm Repairmentioning

confidence: 99%

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

2013

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SummaryNational reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients. More recently, national audits have reported several-fold variations in the care of elderly emergency surgical patients in the UK [4][5][6], and importantly, these data are beginning to be used to drive quality improvement [11] through professional guidance [12][13][14] that advocates early, focused, multidisciplinary 70

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“…Traumatic injury of the aorta is usually immediately fatal; 57%-94% of these patients die at the scene or in the emergency room (1,2). Furthermore, the mortality rate for patients with aortic rupture who survive until they reach the hospital is estimated to be 41%-50% (3).…”

Section: Resultsmentioning

confidence: 99%

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

İslim

Salık²,

Güven³

et al. 2014

Diagn Interv Radiol

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consecutive patients (nine males, two females; age range, 26-80 years) with thoracic and abdominal aortic ruptures underwent endovascular repair in our unit. Thoracoabdominal computed tomography (CT) angiography was performed for diagnosis and follow-up. Patients were selected for endovascular repair by a cardiovascular surgeon, anesthesiologist, and interventional radiologist. All repairs were performed using commercially available stent-grafts. The patients were followed up with CT angiography before discharge, at six months, and yearly thereafter. RESULTSThree patients died by day 30. One patient died due to an unsuccessful procedure and hemodynamic instability; two patients died because of comorbidities. The other eight patients were followed for six to 24 months after the procedure. No endoleaks or late ruptures were observed during the follow-up period. The patient with iatrogenic thoracic aortic rupture developed paraplegia after the procedure. CONCLUSIONReduced mortality due to aortic rupture has been reported with the expanding use of endovascular repair. Reports of small centers are important because of the rarity of these pathologies, and because transferring patients with aortic rupture to a referral center is not usually possible.

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A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair

Abstract: Contrary to the conclusion of recent studies, this paper demonstrates a gradual reduction with time in the operative mortality rate of RAAA repair.

Cited by 499 publications

References 121 publications

Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005–07

Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005–07

Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

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