Outcomes after open repair for ruptured abdominal aortic aneurysms in patients with friendly versus hostile aortoiliac anatomy.
OBJECTIVE
In patients with a ruptured abdominal aortic aneurysm (RAAA), anatomic suitability for endovascular aneurysm repair (EVAR) depends on aortic neck and iliac artery characteristics. If the aortoiliac anatomy is unsuitable for EVAR ("hostile anatomy"), open repair (OR) is the next option. We hypothesized that the death rate for OR is higher in patients with hostile anatomy than in patients with friendly anatomy.


METHODS
We conducted an observational cohort study in 279 consecutive patients with an RAAA treated with OR between 2004 and 2011. The primary endpoint was 30-day or in-hospital death. Aortoiliac anatomy (friendly vs. hostile) was determined prospectively by the vascular surgeon and the interventional radiologist treating the patient. A multivariable logistic regression analysis was done to assess the risk of dying in patients with hostile anatomy after adjustment for age, sex, comorbidity, and hemodynamic stability.


RESULTS
Aortoiliac anatomy was friendly in 71 patients and hostile in 208 patients. Death rate was 38% (95% confidence interval (CI): 28 to 50%) in patients with friendly anatomy and 30% (95% CI: 24 to 37%) in patients with hostile anatomy (p = .23). After multivariable adjustment, the risk of dying was not higher in patients with hostile anatomy (adjusted odds ratio 0.744, 95% CI 0.394 to 1.404).


CONCLUSIONS
The death rate after open repair for an RAAA is comparable in patients with friendly and hostile aortoiliac anatomy.
Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
S C
SC
van Beek
Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
J J
JJ
Reimerink
Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
A C
AC
Vahl
Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands.
W
W
Wisselink
Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands.
J A
JA
Reekers
Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
D A
DA
Legemate
Department of Vascular Surgery, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: r.balm@amc.nl.
R
R
Balm
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
Abdominal; Aneurysm; Aortic aneurysm; Aortoiliac anatomy; Open repair; Ruptured; Vascular surgical procedures