Is emergency endovascular aneurysm repair associated with higher secondary intervention risk at mid-term follow-up?
OBJECTIVE
The study assessed mid-term outcome of emergency endovascular repair for acute infrarenal abdominal aortic aneurysms, with special attention to secondary interventions.


METHODS
Between May 1998 and August 2005, 56 patients underwent emergent endovascular repair for a ruptured abdominal aortic aneurysm (n = 34) or an acute nonruptured abdominal aortic aneurysm (n = 22). During the same period, 322 consecutive patients underwent elective endovascular aneurysm repair and were used as control group. Five types of stent grafts were used: Vanguard, Talent, Excluder, Zenith, and Quantum. Follow-up included abdominal radiograph, duplex ultrasound scanning, and computed tomographic angiography. Outcome measures included all-cause and aneurysm-related mortality, complications, and secondary interventions.


RESULTS
Mortality at 30 days was 18%, 5%, and 1% in the ruptured, acute nonruptured, and elective aneurysm groups, respectively. Overall mean follow-up was 38 +/- 26 months. In the ruptured aneurysm group, survival was 67.8% +/- 8.6% at 1 year and 62.1% +/- 9.5% at 2 and 3 years. Seven secondary interventions (4 early and 3 late) were required in five patients (15%), with a cumulative risk of 9.2% +/- 5.1% at 1 year and 16.2% +/- 8.2% at 2 and 3 years. In the acute nonruptured aneurysm group, survival was 90.9% +/- 6.1% at 1 year, 84.8% +/- 8.2% at 2 years, and 76.4% +/- 10.9% at 3 years. Four secondary interventions (1 early and 3 late) were required in four patients (18%), with a cumulative risk of 9.6% +/- 6.5% at 1 and 2 years and 20.9% +/- 12.0% at 3 years. In the elective aneurysm (control) group, survival was 95.2% +/- 1.2% at 1 year, 89.9% +/- 1.8% at 2 years, and 86.2% +/- 2.1% at 3 years. A total of 51 secondary interventions (4 early, 47 late) were required in 38 patients (12%), with a cumulative risk of 4.2% +/- 1.1% at 1 year, 7.6% +/- 1.6% at 2 years, and 12.9% +/- 2.2% at 3 years.


CONCLUSIONS
To our surprise, emergency endovascular aneurysm repair did not present with higher secondary intervention rate at mid-term follow-up.
Oranen
Björn I
BI
Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands. b.i.oranen@chir.umcg.nl
Bos
Wendy T G J
WT
Verhoeven
Eric L G
EL
Tielliu
Ignace F J
IF
Zeebregts
Clark J
CJ
Prins
Ted R
TR
van den Dungen
Jan J A M
JJ
D017130:Angioplasty / Q000009:adverse effects*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016022:Case-Control Studies; D003422:Critical Care; D017558:Elective Surgical Procedures / Q000009:adverse effects; D004638:Emergency Treatment / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D018579:Patient Selection; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome