Endovascular treatment for ruptured abdominal aortic aneurysm

Abstract

New search run. One new study included. No new studies excluded. Text updated to reflect current Cochrane standards. 'Summary of findings' table added. No change to conclusions.

Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: Disparities in outcomes from a nationwide perspective

“…The option of repair under local anesthesia provided by EVAR potentially compounds this benefit. 6,7 A recently published, large retrospective study of high-risk patients receiving care at the Veterans Affairs Administration who underwent EVAR for elective AAA repair cites a significantly lower 30-day and 1-year mortality in these patients. 14 These benefits of EVAR are also demonstrated in patients presenting with rAAA.…”

“…6 Several case reports and case series have demonstrated acceptable outcomes with EVAR for rAAA, 7-10 but most are small, retrospective, and limited by the lack of a valid control group. In addition, these may represent a highly selective set of results from large-volume expert centers and may not be truly representative of all centers.…”

Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT

“…When this trial was first discussed, observational studies (synthesised in systematic reviews [11][12][13][14] were reporting much lower 30-day mortality for endovascular repair of ruptured AAAs and some such studies 11 have suggested that this should become the new gold standard treatment of ruptured aneurysms without the need for a randomised trial. In addition, the in-hospital and 1-year costs of treating ruptured aneurysms by endovascular repair may be up to 40% lower than for treatment by open repair.…”

Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients

“…3 This might be due to the combined effects of general anesthesia, surgical exposure, hemorrhage, and aortic clamping with lower torso ischemia-reperfusion injury. 7 In 1991, Parodi et al 8 introduced a minimally invasive technique for AAA repair. This endovascular aneurysm repair (EVAR) 8 can be performed under local anesthesia with less blood loss and no need for aortic cross-clamping.…”

“…As a result of lack of randomization, comparative studies so far are flawed by methodologic inadequacies such as selection bias, which is created by inadequate control of potential confounding secondary to inadequate patient matching. 7 Patients who are selected for rEVAR constitute a lower-risk category, presumably because they need to be hemodynamically more stable for preoperative imaging and have a more favorable anatomic configuration.…”