title: Protocol-based strategy for endovascular repair of ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  Compared with conventional open surgery (COS), endovascular aneurysm repair (EVAR) has been reported to decrease the 30-day mortality rate in patients with ruptured abdominal aortic aneurysms (rAAAs). We developed an EVAR-first strategy for rAAAs that incorporates the Shonan ruptured abdominal aortic aneurysm protocol (SRAP). We describe short-term results with this protocol at our institution and compare them with outcomes in patients who underwent COS.
  
  
  METHODS
  The records of all 57 patients in whom a rAAA was repaired during a 7-year period were reviewed retrospectively. Patients in the COS group (n = 30) were treated between January 2005 and December 2009; those in the SRAP group (n = 27) were treated between January 2010 and March 2012. The two groups were compared with respect to patient characteristics at admission, including severity of condition; operative and in-hospital variables; and 30-day mortality.
  
  
  RESULTS
  The baseline patient characteristics in the COS and SRAP groups were similar except that the SRAP group had a significantly higher rate of cerebrovascular disease. The 30-day mortality rate was significantly higher in the COS group (43% vs. 19%), as were the intraoperative mortality rate (27% vs. 5%) and the in-hospital mortality rate (57% vs. 26%; P < 0.05 for all comparisons). The technical success rate for EVAR was 96%; no conversions to open surgery were required.
  
  
  CONCLUSIONS
  Use of the SRAP is a promising strategy for improving initial outcomes in patients with rAAAs.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Ogino
authors.forename: Kazunao
authors.initials: K
authors.lastname: Watanabe
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ikegaya
authors.forename: Jun
authors.initials: J
authors.lastname: Kawachi
authors.forename: Rai
authors.initials: R
authors.lastname: Shimoyama
authors.forename: Naoko
authors.initials: N
authors.lastname: Isogai
keywords: EVAR; abdominal aortic aneurysm; rupture