In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair

Ali, M. Zulfikar; Flahive, Julie; Schanzer, Andres; Simons, Jessica P.; Aiello, Francesco; Doucet, Daniel; Messina, Louis M.; Robinson, William P.

doi:10.1016/j.jvs.2015.01.042

Cited by 57 publications

(42 citation statements)

References 31 publications

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“…Clinical abstractors at these centers prospectively collect over 100 specific variables into distinct modules. [21][22][23] The Boston University School of Medicine Institutional Review Board approved this study and informed consent was waived. We analyzed the PVI lower extremity module.…”

Section: Methodsmentioning

confidence: 99%

Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

Siracuse

Orden

Kalish

et al. 2017

Journal of Vascular Surgery

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Section: Methodsmentioning

confidence: 99%

Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

Siracuse

Orden

Kalish

et al. 2017

Journal of Vascular Surgery

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“…The derivation and validation of the VSGNE RAAA risk score and the validity of the VSGNE RAAA risk score for predicting in-hospital mortality after EVAR or OR of RAAA have been previously described. 13,14 Briefly, independent predictors of mortality included in the VSGNE RAAA risk score include age >76 years, preoperative cardiac arrest, loss of consciousness, and suprarenal aortic clamp. The VSGNE RAAA risk score (range, 0-6) is tabulated by summing points given to each of the four variables.…”

Section: Methodsmentioning

confidence: 99%

Endovascular repair of ruptured abdominal aortic aneurysms does not reduce later mortality compared with open repair

Robinson

Schanzer

Aiello

et al. 2016

Journal of Vascular Surgery

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EVAR does not independently reduce long-term mortality compared with OR. Patient comorbidities and indices of shock on admission are the primary independent determinants of long-term mortality. However, the lower early mortality observed in the Vascular Quality Initiative for patients selected to undergo EVAR of RAAA compared with patients selected for OR is sustained over time, suggesting that EVAR for RAAA is beneficial in appropriate candidates. Better elucidation of the key selection factors, including aneurysm anatomy, is needed to best select patients for EVAR and OR to reduce long-term mortality.

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“…Age has always been reported to be an influential factor when outcome is evaluated in surgical series [1, 22, 27, 31, 32]. It is clear that the number of aged patients is high among the untreated in this and other series.…”

Section: Discussionmentioning

confidence: 65%

“…During the study period, a shift in the care of patients was performed in the County, and an “EVAR first strategy” was developed, which have been reported by others [2–4, 23, 27]. This started in 2010–2011, and specific analysis has therefore not been analyzed in detail.…”

Section: Discussionmentioning

confidence: 99%

A Majority of Admitted Patients With Ruptured Abdominal Aortic Aneurysm Undergo and Survive Corrective Treatment: A Population‐Based Retrospective Cohort Study

et al. 2016

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BackgroundAbdominal aortic aneurysm (AAA) is an asymptomatic, potentially lethal condition predominantly found in elderly. The mortality is 100 % if rupture occurs and left untreated, but even in treated patients the mortality is substantial. Female sex and treatment with open repair rather than endovascular aortic repair (EVAR) have been reported to negatively affect outcome. The objective was to describe the contemporary care and outcome of all treated and untreated patients with ruptured AAA (rAAA) admitted to hospital.MethodPopulation-based retrospective investigation, including all patients admitted to the emergency departments within Stockholm County diagnosed with rAAA 2009–2013. All identified patients’ charts (n = 297) were analyzed; the study cohort includes 283 verified patients.ResultsMen were in majority [214 (76 %), 69 (24 %) women] and were younger than women (78 vs 82 years, p < 0.001). A majority of patients were treated (212/283, 75 %), a similar proportion of women and men. Untreated patients had a higher mean age (84 vs 77 years, p < 0.001). The proportion treated with EVAR was 27 %, and they were older than OR treated (79 vs 76 years, p = 0.043). Forty-seven percentage of patients admitted with rAAA survived 30 days, and 62 % of treated patients survived 30 days. The 30-day mortality for women and men was similar.ConclusionsOur results and other contemporary series show a shift toward a higher rate of treated patients with rAAA, and improving outcomes, similar for women and men. The increased use of EVAR contributes to this improvement in short-term outcome. High age influences the willingness to treat patients with rAAA.

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In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair

Cited by 57 publications

References 31 publications

Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

Endovascular repair of ruptured abdominal aortic aneurysms does not reduce later mortality compared with open repair

A Majority of Admitted Patients With Ruptured Abdominal Aortic Aneurysm Undergo and Survive Corrective Treatment: A Population‐Based Retrospective Cohort Study

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