title: A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  To retrospectively compare a single center's immediate and mid-term outcomes of ruptured abdominal aortic aneurysm open and endovascular repair (EVAR) for two patient groups-hemodynamically stable and unstable patients-in the same time period.
  
  
  METHODS
  Patients presenting at our center with confirmed rupture of an abdominal aortic aneurysm between December 1999 and April 2006 were considered according to an intention-to-treat model with EVAR. Patients with symptomatic or acute (but not ruptured) AAAs were not included in this study. Thirty-three patients underwent EVAR, and 91 underwent open repair. Seventy-two patients (EVAR, 45%; open, 63%) were classified as hemodynamically unstable at arrival, and 52 were classified as stable (EVAR, 55%; open, 37%). Ninety-seven percent of EVAR procedures commenced under local anesthesia, and 100% of open repairs occurred with general anesthesia. Overall successful graft deployment, 30-day mortality, overall reintervention rate, and complications were the study primary end points.
  
  
  RESULTS
  Overall successful graft deployment for EVAR was 91%; for open repair, it was 96%. Overall 30-day mortality for EVAR was 30% (unstable, 53%; stable, 11%), and the rate was 46% for open repair (unstable, 61%; stable, 21%). The EVAR postoperative reintervention rate (within 30 days) was 15% (unstable, 20%; stable, 11%), and for open repair it was 10% (unstable, 9%; stable, 15%). We recorded a 27% severe complication rate for EVAR patients (unstable, 40%; stable, 17%), and for patients treated with open repair, it was 33% (unstable, 35%; stable, 29%). Our overall EVAR eligibility rate was 52%, and our overall EVAR treatment rate was 27%.
  
  
  CONCLUSIONS
  Our study's overall results for EVAR remain encouraging when compared with those of conventional repair, but large randomized trials are required to confirm the efficacy of the procedure.
authors.affiliation: Department of Vascular Surgery, Policlinico Hospital of Modena and University of Studies of Modena and Reggio Emilia, Modena, Italy. g.coppi@ausl.mo.it
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Coppi
authors.forename: Roberto
authors.initials: R
authors.lastname: Silingardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Gennai
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saitta
authors.forename: Anna Vittoria
authors.initials: AV
authors.lastname: Ciardullo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome