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Option of Open or Endovascular AAA Rupture Repair Cuts Mortality

Sunday, 06 July 2008 01:11 Ramaz Mitaishvili
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In a single-center study, the availability of both open and endovascular repair significantly improved postoperative survival in patients with ruptured abdominal aortic aneurysms (rAAA), according to a report in the Archives of Surgery for June.

In the study, Dr. Andreas Wibmer from the Medical University of Vienna, Austria, and colleagues compared the outcomes of patients who were treated when only open repair was available with those of patients treated when both open and endovascular repair were available.

Data were collected between October 1999 and July 2006, and the patients evaluated in two groups - the first 41 months and the second 41 months.

During the first 41-month period, 42 patients underwent open repair, while during the second 41-month period, 31 patients underwent open repair and 16 were treated with endovascular repair.

Overall postoperative mortality fell significantly after the offering of both repair procedures (p < 0.03), the authors report.

The availability of both procedures was associated with a drop in 90-day mortality from 54.8% to 27.7% (p < 0.01). The reduced mortality was particularly evident in patients older than 75.5 years: 75.0% vs. 28.6% (p < 0.01).

With the introduction of endovascular repair, mortality in patients undergoing open repair fell from 54.8% to 29.0%.

"Our findings strongly indicate that the implementation of endovascular abdominal aortic aneurysm repair is able to reduce the overall mortality in patients with rAAA," the investigators conclude. "By offering both treatment options, it was possible to improve the immediate and mid-term overall results by shifting high-risk patients from the open graft reduction to the endovascular abdominal aortic aneurysm repair group, thereby improving the results of open surgery."

Further research, however, is needed to determine the best candidates for endovascular repair, they note. The current findings suggest that older, hemodynamically stable patients may benefit most.

Arch Surg 2008;143:544-549.

Reviewed by Ramaz Mitaishvili, MD
 
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