Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.
BACKGROUND
Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial.


OBJECTIVE
To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers.


METHODS
Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible and included treatment details from a single center and information on 1037 patients treated by EVAR and 763 patients treated by open repair (OR).


RESULTS
Overall 30-day mortality after EVAR in 1037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean 49.1%) of their patients, had a 30-day mortality of 19.7% (range: 0%-32%) for 680 EVAR patients and 36.3% (range: 8%-53%) for 763 OR patients (P < 0.0001). Supraceliac aortic balloon control was obtained in 19.1% +/- 12.0% (+/-SD) of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% +/- 8.3% (+/-SD) of these EVAR patients.


CONCLUSIONS
These results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is better than OR for treating RAAA patients provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.
Veith
Frank J
FJ
Cleveland Clinic, Cleveland, OH; daggerNew York University Medical Center, New York, NY, USA. fjvmd@msn.com
Lachat
Mario
M
Mayer
Dieter
D
Malina
Martin
M
Holst
Jan
J
Mehta
Manish
M
Verhoeven
Eric L G
EL
Larzon
Thomas
T
Gennai
Stefano
S
Coppi
Gioacchino
G
Lipsitz
Evan C
EC
Gargiulo
Nicholas J
NJ
van der Vliet
J Adam
JA
Blankensteijn
Jan
J
Buth
Jacob
J
Lee
W Anthony
WA
Biasi
Giorgio
G
Deleo
Gaetano
G
Kasirajan
Karthikeshwar
K
Moore
Randy
R
Soong
Chee V
CV
Cayne
Neal S
NS
Farber
Mark A
MA
Raithel
Dieter
D
Greenberg
Roy K
RK
van Sambeek
Marc R H M
MR
Brunkwall
Jan S
JS
Rockman
Caron B
CB
Hinchliffe
Robert J
RJ
D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D003625:Data Collection; D006801:Humans; D011795:Surveys and Questionnaires