title: A 15-Year Single-Center Experience of Endovascular Repair for Elective and Ruptured Abdominal Aortic Aneurysms.
abstract: OBJECTIVE
  To evaluate the differences in technical outcomes and secondary interventions between elective endovascular aneurysm repair (el-EVAR) procedures and those for ruptured aneurysms (r-EVAR).
  
  
  METHODS
  Of the 906 patients treated with primary EVAR from September 1998 until July 2012, 43 cases were excluded owing to the use of first-generation stent-grafts. Among the remaining 863 patients, 773 (89.6%) patients (mean age 72 years; 697 men) with asymptomatic or symptomatic abdominal aortic aneurysms (AAAs) were assigned to the el-EVAR group; 90 (10.4%) patients (mean age 73 years; 73 men) were assigned to the r-EVAR group based on blood outside the aortic wall on preoperative imaging. The primary study outcome was technical success; secondary endpoints, including freedom from secondary interventions and late survival, were examined with Kaplan-Meier analyses.
  
  
  RESULTS
  At baseline, r-EVAR patients had larger aneurysms on average (p<0.001) compared to el-EVAR patients. Technical success was comparable (p=0.052), but there were more type Ia endoleaks at completion angiography in the r-EVAR group (p=0.038). As anticipated, more patients died in the first month in the r-EVAR group (18.9% vs 2.2% el-EVAR, p<0.001). At 5 years, there was an overall survival of 65.1% for the el-EVAR patients vs 48.1% in the r-EVAR group (p<0.001). The freedom from AAA-related mortality was 95.7% for el-EVAR and 71.0% for r-EVAR (p<0.001). Five-year freedom from type I/III endoleaks was significantly lower in the r-EVAR group (78.7% vs 90.0%, p=0.003). Five-year freedom from secondary intervention estimates were not significantly different (el-EVAR 84.2% vs r-EVAR 78.2%, p=0.064).
  
  
  CONCLUSIONS
  Within our cohort of primary EVAR patients, r-EVAR cases showed comparable stent-graft-related technical outcome. Although there was a higher incidence of type Ia endoleaks on completion angiography in the r-EVAR group, the overall secondary intervention rate was comparable to el-EVAR.
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands.
authors.forename: Pieter P H L
authors.initials: PP
authors.lastname: Broos
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands.
authors.forename: Yannick W
authors.initials: YW
authors.lastname: 't Mannetje
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands.
authors.forename: Rutger A
authors.initials: RA
authors.lastname: Stokmans
authors.affiliation: Department of Education and Research, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Houterman
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands Department of Vascular and Endovascular Surgery, University of Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Corte
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Philippe W M
authors.initials: PW
authors.lastname: Cuypers
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, the Netherlands.
authors.forename: Joep A W
authors.initials: JA
authors.lastname: Teijink
authors.affiliation: Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands marc.v.sambeek@catharinaziekenhuis.nl.
authors.forename: Marc R H M
authors.initials: MR
authors.lastname: van Sambeek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; complications; endoleak; endovascular aneurysm repair; reinterventions; ruptured aneurysm; stent-graft