The importance of anatomical suitability and fitness for the outcome of endovascular repair of ruptured abdominal aortic aneurysm.
BACKGROUND
Endovascular repair of aortic aneurysm (EVAR) has a lower mortality than open repair. The aim of this study was to assess mortality from EVAR for emergency AAA repair and the impact of fitness for operation and adverse anatomy.


METHODS
One-hundred and forty two patients who had EVAR for a ruptured AAA (80, REVAR) or a symptomatic AAA (62, SEVAR) between 1994 and 2007 in a single specialist endovascular centre were reviewed. Fitness for surgery was assessed by Hardman's index (age>76, loss of consciousness, Hb<9.0, Cr>190, ischaemic ECG). CT scans were reviewed, compared with operative images and operation notes for adverse anatomy. Details of perioperative complications, and outcome were recorded.


RESULTS
Overall mortality at 24-h, 30-days and one year were, respectively: 17%, 36%, 50% for REVAR and 5%, 8%, 23% for SEVAR. Overall adverse anatomy increased 30-day mortality. Hardman's index of three or more increased mortality HR=2.59 (1.24-5.41), p=0.01. On Cox regression Univariate analysis increasing Hardman's index score and adverse anatomy increased the overall mortality over time. In multivariate Cox regression analysis (controlled for the Hardman's index) adverse anatomy was associated with significant increase in graft related mortality.


CONCLUSIONS
The use of EVAR is feasible in patients who present with a ruptured or acutely symptomatic AAA. Care must be taken not to extend anatomical or clinical guidelines.
Richards
T
T
University College Hospital, Euston Road, London NW1 2PG, United Kingdom. toby.richards@ucl.ac.uk
Goode
S D
SD
Hinchliffe
R
R
Altaf
N
N
Macsweeney
S
S
Braithwaite
B
B
D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D004638:Emergency Treatment; D005240:Feasibility Studies; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015415:Biomarkers; D006454:Hemoglobins; D003404:Creatinine