Mortality after endovascular repair of ruptured abdominal aortic aneurysms: a systematic review and meta-analysis.
OBJECTIVE
To document mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs).


METHODS
MEDLINE and EMBASE databases.


METHODS
Articles that reported data on mortality after endovascular repair of RAAAs were identified. Only patients with true ruptures were included. Additionally, information on mortality after concurrent open repair was sought.


METHODS
One of the authors reviewed all of the studies and extracted appropriate data. A total of 43 articles were identified, 14 of which were excluded.


RESULTS
Twenty-nine articles with 897 patients who underwent endovascular repair met the inclusion criteria. Of the patients with available information, 86% were men; 29% had been operated on under local anesthesia; 28% were hemodynamically unstable; 17% required intra-aortic balloon occlusion; 48% received bifurcated stent grafts; 6% had endovascular procedures converted to open repair intraoperatively; and 5.5% developed abdominal compartment syndrome. In-hospital and/or 30-day mortality ranged between 0% and 54% in different series, whereas the pooled mortality after endovascular repair was 24.5% (95% confidence interval [CI], 19.8%-29.4%). In 19 studies reporting results of both endovascular and concurrent open repair from the same unit, the pooled mortality after open repair was 44.4% (95% CI, 40.0%-48.8%), and the pooled overall mortality for RAAA undergoing endovascular or open repair was 35% (95% CI, 30%-41%).


CONCLUSIONS
Endovascular repair of RAAAs is associated with acceptable mortality rates. Additional studies will be required to verify these promising results and precisely define the role of endovascular treatment as an additional therapeutic option for RAAAs.
Karkos
Christos D
CD
5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocrateio Hospital, Konstantinoupoleos 49, Thessaloniki 546 42, Greece. ckarkos@hotmail.com
Harkin
Denis W
DW
Giannakou
Andry
A
Gerassimidis
Thomas S
TS
D017542:Aneurysm, Ruptured / Q000401:mortality* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans