AUTHOR=Fang Gang , Yue Jianing , Shuai Tao , Yuan Tong , Ren Bichen , Fang Yuan , Pan Tianyue , Liu Zhenjie , Dong Zhihui , Fu Weiguo 

TITLE=Comparison between endovascular aneurysm repair-selected and endovascular aneurysm repair-only strategies for the management of ruptured abdominal aortic aneurysms: An 11-year experience at a Chinese tertiary hospital

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.870378

DOI=10.3389/fcvm.2022.870378

ISSN=2297-055X

ABSTRACT=Objectives: The aim of this study was to review our management experience of ruptured abdominal aortic aneurysms (RAAAs) using an endovascular aneurysm repair (EVAR)-only strategy, and discuss the feasibility of this strategy. 

Materials and methods: A retrospective analysis of clinical data was performed in patients with RAAAs from January 2009 to October 2020. Our strategy towards operative treatment for RAAAs evolved from an EVAR-selected (from January 2009 to April 2014) to an EVAR-only (from May 2014 to October 2020) strategy. Baseline characteristics, thirty-day mortality, perioperative complications, and long-term outcomes of patients were compared between the two periods. 
Results: A total of 93 patients undergoing emergent RAAA repair were eventually included. The overall operation rate in RAAAs at our centre was 70.5% (93/132). In the EVAR-only period, all 53 patients underwent ruptured endovascular aneurysm repair (rEVAR). However, only 47.5% (19/40) of patients in the EVAR-selected period underwent rEVAR, and the remaining 21 patients underwent emergent open surgery. Thirty-day mortality in the EVAR-only group was 22.6% (12/53) compared with 25.0% (10/40) for the EVAR-selected group (P=0.79). Systolic blood pressure ≤70 mmHg (adjusted odds ratio (OR) 4.99, 95% confidence interval (CI) 1.13-22.08, P=0.03) and abdominal compartment syndrome (adjusted OR 3.72, 95% CI 1.12-12.32, P=0.03) were identified as independent risk factors responsible for 30-day mortality. After five years, 47.5% (95% CI, 32.0%-63.0%) of patients in the EVAR-selected group were still alive versus 49.1% (95% CI, 32.3%-65.9%) of patients in the EVAR-only group (P=0.29).

Conclusions: The EVAR-only strategy has allowed rEVAR to be used in nearly all the RAAAs with similar mortality comparing with the EVAR-selected strategy. Due to the avoidance of operative modality selection, the EVAR-only strategy was associated with a more simplified algorithm, less influence on haemodynamics, and a shorter operation and recovery time.