Early mortality following endovascular versus open repair of ruptured abdominal aortic aneurysms.
OBJECTIVE
To determine whether endovascular repair (EVAR) offers a survival advantage over open repair (OAR) with ruptured abdominal aortic aneurysms (RAAA).


METHODS
Retrospective analysis of RAAA patients treated between 2003 and 2008. Univariate and multivariate analyses were performed.


RESULTS
167 patients presented with RAAA (OAR = 135, 80.8%, EVAR = 32, 19.2%). On univariate analysis, EVAR was associated with a decreased mortality relative to OAR, (15.6% vs 43.7%, P = .004). Patients who survived were younger (P < .0005), had a higher blood pressure (P < .0005), level of consciousness (P < .0005), and hemoglobin (P = .018), and a lower urea (P = .005) and international normalized ratio (INR; P = .001). On multivariate analysis, type of repair remained an independent predictor of 30-day mortality (OR: 0.121; 95% CI: 0.021-0.682, P = .017).


CONCLUSIONS
Controlling for preoperative factors, EVAR is an independent predictor of lower 30 day mortality relative to open repair after RAAA. This supports the wider use of endovascular repair in all patients with RAAA.
Chagpar
Ryaz B
RB
Division of Vascular Surgery, London Health Sciences Centre and The University of Western Ontario, London, ON, Canada.
Harris
Jeremy R
JR
Lawlor
D Kirk
DK
DeRose
Guy
G
Forbes
Thomas L
TL
D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000097:blood / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality*; D003243:Consciousness; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D016017:Odds Ratio; D009864:Ontario; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
D006454:Hemoglobins; D014508:Urea