Endovascular repair of ruptured abdominal aortic aneurysms: systematic literature review.
Endovascular repair is increasingly used for ruptured abdominal aortic aneurysms (RAAAs). This study estimated the mortality rate for this approach. A review of 307 publications in English was performed. Thirty-four publications representing 1,200 patients with RAAA were deemed appropriate for analysis by weighted least squares regression. Of the 1,200 patients, 531 (44.3%) underwent endovascular aneurysm repair (EVAR). The average age was 74 years, and 13% were female. Aortouni-iliac grafts were used in 49.4% of patients, and 50.6% received bifurcated grafts. The technical success rate was 94.9%, with a mortality rate of 30.2%. The ratio of endovascular cases to the total number of cases strongly predicted the mortality rate (weighted coefficient -0.378, p< .0003). The mortality rate following EVAR of RAAA is 30%. A 3.8% reduction in mortality was found for each 10% increase in the percentage of ruptures repaired endovascularly at each center. These results are suggestive of a learning curve.
Azizzadeh
Ali
A
Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA. Ali.Azizzadeh@uth.tmc.edu
Villa
Martin A
MA
Miller
Charles C
CC
Estrera
Anthony L
AL
Coogan
Sheila M
SM
Safi
Hazim J
HJ
D000368:Aged; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing