title: Endovascular treatment for ruptured abdominal aortic aneurysm.
abstract: BACKGROUND
  An abdominal aortic aneurysm (AAA) (the pathological enlargement of the aorta) can develop in both men and women as they grow older. It is most commonly seen in men over the age of 65 years. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, a fatal event unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open surgical repair. A newer minimally invasive technique, endovascular repair, has been shown to reduce early morbidity and mortality, as compared to conventional open surgery, for planned AAA repair. Emergency endovascular repair (eEVAR) has been used successfully to treat ruptured abdominal aortic aneurysm (RAAA), proving that it is feasible in selected patients. However, it is not yet known if eEVAR will lead to significant improvements in outcomes for these patients or indeed if it can replace conventional open repair as the preferred treatment for this lethal condition.
  
  
  OBJECTIVE
  To compare the advantages and disadvantages of eEVAR in comparison with conventional open surgical repair for the treatment of RAAA.
  
  
  METHODS
  The Cochrane Peripheral Vascular Diseases Group searched their trials register (last searched October 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) database (last searched Issue 4, 2006). We searched a number of electronic databases and handsearched relevant journals until March 2006 to identify studies for inclusion.
  
  
  METHODS
  Randomised controlled trials in which patients with a confirmed ruptured abdominal aortic aneurysm were randomly allocated to eEVAR, or conventional open surgical repair.
  
  
  METHODS
  Studies identified for potential inclusion were independently assessed for eligibility by at least two reviewers, with excluded studies further checked by the agreed arbitrators. As no randomised controlled trials were identified at present no tests of heterogeneity or sensitivity analysis were performed.
  
  
  RESULTS
  There were no randomised controlled trials identified at present comparing eEVAR with conventional open surgical repair for the treatment of RAAA.
  
  
  CONCLUSIONS
  There is no high quality evidence to support the use of eEVAR in the treatment of RAAA. However, evidence from prospective controlled studies without randomisation, prospective studies, and retrospective case series suggest that eEVAR is feasible in selected patients, with outcomes comparable to best conventional open surgical repair for the treatment of RAAA . Furthermore, endovascular repair in selected patients may be associated with a trend towards reductions in blood loss, duration of intensive care treatment, and mortality.
authors.affiliation: Royal Victoria Hospital, Vascular Surgery Unit, Grosvenor Road, Belfast, Northern Ireland, UK. mariannedillon@doctors.org
authors.forename: M
authors.initials: M
authors.lastname: Dillon
authors.forename: C
authors.initials: C
authors.lastname: Cardwell
authors.forename: P H
authors.initials: PH
authors.lastname: Blair
authors.forename: P
authors.initials: P
authors.lastname: Ellis
authors.forename: F
authors.initials: F
authors.lastname: Kee
authors.forename: D W
authors.initials: DW
authors.lastname: Harkin
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D006801:Humans; D014656:Vascular Surgical Procedures / Q000379:methods