title: Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm.
abstract: OBJECTIVE
  To compare the midterm re-intervention and survival rates after EVAR and OR for ruptured abdominal aortic aneurysms (RAAA).
  
  
  METHODS
  Observational cohort study including all consecutive RAAA patients between 2004 and 2011 in 10 hospitals in the Amsterdam ambulance region. The primary end point was re-interventions within 5 years of the primary intervention. The secondary end point was death. The outcomes were estimated by survival analyses, compared using the logrank test, and subsequently adjusted for possible confounders using Cox proportional hazard models. Re-interventions were estimated in all patients and in patients who survived their hospital stay.
  
  
  RESULTS
  Of 467 patients with a RAAA, 73 were treated by EVAR and 394 by OR. Five years after the primary intervention, the rates of freedom from re-intervention were 55% for EVAR (26/73, 95% CI: 41-69%) and 60% for OR (130/394, 95% CI: 55-66%) (p = .96). After adjustment for age, sex, comorbidity, and pre-operative hemodynamic stability, the risk of re-intervention was similar (HR 1.01, 95% CI: 0.65-1.55). The survival rates were 36% for EVAR (45/73, 95% CI: 24-47%) and 38% for OR (235/394, 95% CI: 33-43%) (p = .83). In 297 patients who survived their hospital stay, the rates of freedom from re-intervention were 66% for EVAR (15/54, 95% CI: 52-81%) and 90% for OR (20/243, 95% CI: 86-95%) (p < .01). After adjustment for age and sex, the risk of re-intervention was higher after EVAR (HR 0.27, 95% CI: 0.14-0.52).
  
  
  CONCLUSIONS
  Five years after the primary intervention, endovascular and open repair for ruptured abdominal aortic aneurysm resulted in similar re-intervention and survival rates. However, in patients who survived their hospital stay the re-intervention rate was higher for EVAR than for OR.
authors.affiliation: Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S C
authors.initials: SC
authors.lastname: van Beek
authors.affiliation: Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Vahl
authors.affiliation: Department of Vascular Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Wisselink
authors.affiliation: Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Reekers
authors.affiliation: Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: D A
authors.initials: DA
authors.lastname: Legemate
authors.affiliation: Department of Vascular Surgery, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: r.balm@amc.nl.
authors.forename: R
authors.initials: R
authors.lastname: Balm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Abdominal; Aneurysm; Aortic aneurysm; Endovascular aneurysm repair; Midterm outcomes; Ruptured; Ruptured abdominal aortic aneurysm; Vascular surgical procedures