Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair

Abstract

Our analysis provides evidence to motivate the adoption of an EVAR-first policy in a nonelective setting and the establishment of standardized protocols for the management ruptured AAAs.

Ruptured abdominal aortic aneurysm: open vs. endovascular repair: literature review

“…A further meta-analysis incorporating the data from the three multi-centre RCTs corroborated these findings (pooled odds ratio 0.88, 95% CI: 0.66-1.18; P=0.84) [36]. Conversely, a further meta-analysis including two RCTs and 39 observational studies, revealed a statistically significant early mortality benefit of EVAR compared to OR (odds ratio 0.56, 95% CI: 0.50-0.65; P<0.01) [37]. Numerous other observational studies also report in favour of EVAR [12,38,39], with authors commonly acknowledging the significant limitations of their work; citing variable management protocols, selection bias, sub-optimal methodological considerations and associated with minimally-invasive techniques, such as avoidance of laparotomy, reduction in tissue damage and haemorrhage, reduced risk of hypothermia, and a diminished requirement for deep anaesthesia [17,18].…”

“…More specifically, participants who are haemodynamically stable are often assigned to EVAR, introducing a well-defined selection bias [42]. While there is an accompanying body of observational research failing to reveal any early-mortality benefit in utilising an endovascular approach [15,31,36,40,[43][44][45], there are virtually no literature items reporting EVAR as a more morbid curative approach [37]. So while there is no high-level evidence from randomised trials supporting EVAR over OR from an early mortality perspective [15,36], the trends within observational research favour the former.…”

Efficacy of endovascular management approach of ruptured abdominal aortic aneurysm

“…35 IMPROVE study shows that patients with suspected, but no evidence of ruptured AAA, the open surgical or endovascular are equally valid. 51 Although the mortality rates associated with the correction of the ruptured AAA with open surgery versus endovascular correction can be contested, perioperative morbidity rates have been consistently and significantly lower for EVAR, in comparison with the open repair in randomized trials of elective AAA. [51][52][53][54] Extrapolating from these findings, it appears that EVAR would be highly desirable in patients with ruptured AAA who have poor prognosis factors for the open repair.…”

Abdominal Aortic Aneurysm : Aspects on how to affect mortality from rupture

“…Since then, a number of systematic reviews and meta---analyses and two RCTs (where one was single centre and stopped after 32 patients, thus more regarded as a pilot study (Hinchliffe et al 2006)), have been published (Sadat et al 2008, Rayt et al 2008, Antoniou et al 2013, Reimerink et al 2013a). …”

“…They found the OR for in---hospital mortality for the EVAR---treated rAAA---patients to be 0.58 (CI 0.46---0.73) p<0.01, compared to OAR (Antoniou et al 2013). They proposed an EVAR---first policy in the non---elective setting.…”