Abstract
Objectives: Rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Without repair, ruptured AAA (rAAA) is nearly always fatal. Endovascular aneurysm repair (EVAR) has shown a reduction in 30-day mortality relative to that achieved with open repair in the elective AAA operation. However, in the emergency surgery for rAAA, the effectiveness of EVAR is unknown and the survival benefit of EVAR is not well established. In this study, we evaluated the short-term results of EVAR compared with open repair in patients with rAAA. Methods: We retrospectively reviewed the medical records of 52 patients who underwent rAAA repair from April 2004 to March 2013 in our institution. From April 2004 to December 2010, open surgical treatment was the first choice for patients with rAAA. From 2011 on, EVAR is the treatment of first choice if a patient has suitable anatomy. A total of 52 patients with rAAA were treated, 39 by open means and 13 by endovascular means. Procedure for EVAR for rAAA includes; 1. Aortic occlusion balloon (AOB) insertion for hemodynamically unstable patients. 2. Laparotomy for abdominal compartment syndrome (ACS) prevention. 3. Vacuum assisted closure (VAC) system @(KCI) usage for abdominal drainage and infection management. Results: The overall mortality rate was 11.5% (6/52). These 6 patients who died had unstable preoperative hemodynamic state (“deep shock” condition). The mortality rate for open repair was 12.8% and for EVAR 7.7%. Compared with open repair, EVAR resulted in lower rate of bleeding complication, shorter hospital stay and higher discharge to home rate. Intra-abdominal pressure for EVAR patients was less than 20 mmHg and no ACS was observed. Conclusion: There was no significant difference between EVAR and open repair in terms of perioperative mortality. However, EVAR for rAAA involves less recovery time and higher discharge to home rate. Although further evaluation exploring the long-term survival benefit of EVAR is necessary, our result suggests that EVAR may improve the survival of patients with rAAA.
