Document Detail


Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience.
MedLine Citation:
PMID:  23095611     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To present the combined 14-year experience of 2 university centers performing endovascular aneurysm repair (EVAR) on 100% of noninfected ruptured abdominal aortic aneurysms (RAAA) over the last 32 months.
BACKGROUND: Endovascular aneurysm repair for RAAA feasibility is reported to be 20% to 50%, and EVAR for RAAA has been reported to have better outcomes than open repair.
METHODS: We retrospectively analyzed prospectively gathered data on 473 consecutive RAAA patients (Zurich, 295; Örebro, 178) from January 1, 1998, to December 31, 2011, treated by an "EVAR-whenever-possible" approach until April 2009 (EVAR/OPEN period) and thereafter according to a "100% EVAR" approach (EVAR-ONLY period).Straightforward cases were treated by standard EVAR. More complex RAAA were managed during EVAR-ONLY with adjunctive procedures in 17 of 70 patients (24%): chimney, 3; open iliac debranching, 1; coiling, 8; onyx, 3; and chimney plus onyx, 2.
RESULTS: Since May 2009, all RAAA but one have been treated by EVAR (Zurich, 31; Örebro, 39); 30-day mortality for EVAR-ONLY was 24% (17 of 70). Total cohort mortality (including medically treated patients) for EVAR/OPEN was 32.8% (131 of 400) compared with 27.4% (20 of 73) for EVAR-ONLY (P = 0.376). During EVAR/OPEN, 10% (39 of 400) of patients were treated medically compared with 4% (3 of 73) of patients during EVAR-ONLY. In EVAR/OPEN, open repair showed a statistically significant association with 30-day mortality (adjusted odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.4-7.5; P = 0.004). For patients with no abdominal decompression, there was a higher mortality with open repair than EVAR (adjusted OR = 5.6; 95% CI, 1.9-16.7). In patients with abdominal decompression by laparotomy, there was no difference in mortality (adjusted OR = 1.1; 95% CI, 0.3-3.7).
CONCLUSIONS: The "EVAR-ONLY" approach has allowed EVAR treatment of nearly all incoming RAAA with low mortality and turndown rates. Although the observed association of a higher EVAR mortality with abdominal decompression needs further study, our results support superiority and more widespread adoption of EVAR for the treatment of RAAA.
Authors:
D Mayer; S Aeschbacher; T Pfammatter; F J Veith; L Norgren; A Magnuson; Z Rancic; M Lachat; T Hörer; P Skoog; T Larzon
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Annals of surgery     Volume:  256     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-25     Completed Date:  2013-01-04     Revised Date:  2014-04-03    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  688-95; discussion 695-6     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Algorithms
Aneurysm, Ruptured / mortality,  surgery*
Aortic Aneurysm, Abdominal / mortality,  surgery*
Chi-Square Distribution
Endovascular Procedures / methods*,  mortality
Female
Humans
Male
Retrospective Studies
Survival Rate
Sweden / epidemiology
Switzerland / epidemiology
Treatment Outcome
Comments/Corrections
Erratum In:
Ann Surg. 2013 Jul;258(1):191
Note: Hörer, T [added]; Skoog, P [added]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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