title: An emergency EVAR service reduces mortality in ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  The aim of this study was to compare all in-hospital mortality for ruptured abdominal aortic aneurysms (rAAAs) before and after the establishment of an emergency EVAR (eEVAR) service.
  
  
  METHODS
  An eEVAR service was established in January 2006, since when all patients presenting with rAAAs have been considered for endovascular repair. Data for all rAAAs presenting between January 2006 and December 2007 was prospectively collected (Group 1). This patient group was compared to those presenting with rAAA between January 2003 and December 2005 when eEVAR was not offered at our institution (Group 2). These records had also been collected prospectively and submitted to the National Vascular Database (NVD).
  
  
  RESULTS
  A total of 50 rAAAs (17 eEVAR, 29 open repairs, 4 palliated) presented after the introduction of eEVAR (Group 1) and 71 in the historical Group 2 of which 54 underwent open repair and 17 were palliated. The total in-hospital mortality was significantly lower in Group 1 20% (eEVAR (n=1), 6%: Open (n=5), 17%: palliated (n=4), 100%) when compared to Group 2 54% (Open (n=21), 39%: palliated (n=17), 100%) (p=0.000001). Furthermore similar significant differences were seen in 30-day operative mortalities between the two groups 13% in Group 1 versus 39% in Group 2 (p=0.0003). In addition the proportion of patients who were palliated has significantly decreased (8% Group 1 versus 24% Group 2, p=0.01).
  
  
  CONCLUSIONS
  The establishment of an eEVAR service has significantly reduced in-hospital mortality for patients presenting with ruptured abdominal aortic aneurysms.
authors.affiliation: Cambridge Vascular Unit, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
authors.forename: U
authors.initials: U
authors.lastname: Sadat
authors.forename: P D
authors.initials: PD
authors.lastname: Hayes
authors.forename: P J
authors.initials: PJ
authors.lastname: Kullar
authors.forename: C
authors.initials: C
authors.lastname: Cousins
authors.forename: K
authors.initials: K
authors.lastname: Varty
authors.forename: J R
authors.initials: JR
authors.lastname: Boyle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery*; D016063:Blood Loss, Surgical; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality*; D019992:Databases as Topic; D004638:Emergency Treatment / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D010166:Palliative Care; D019106:Postoperative Hemorrhage / Q000209:etiology; D015397:Program Evaluation; D011446:Prospective Studies; D016896:Treatment Outcome