Improved survival after abdominal aortic aneurysm rupture by offering both open and endovascular repair.

BACKGROUND: In the treatment of ruptured abdominal aortic aneurysm (rAAA), the results of open graft replacement (OGR) have remained constant but discouraging for the last 4 decades. Provided suitable anatomy, elective endovascular abdominal aortic aneurysm repair (EVAR) is less invasive and leads to improved perioperative mortality. Thus, it is reasonable to assume that endovascular treatment should improve the results of rAAA therapy.

OBJECTIVE: To determine whether the use of both endovascular and open repair of rAAA leads to improved results.

DESIGN: A single-center, retrospective analysis of 89 patients suffering from rAAA treated either by EVAR or OGR.

PATIENTS: From October 1999 until July 2006, a consecutive series of patients with rAAA were analyzed. Time was divided into 2 periods of 41 months. During the first period, 42 patients were treated by OGR exclusively. Period 2 started with the availability of an EVAR protocol to treat rAAA; 31 patients received open repair while 16 patients underwent EVAR.

MAIN OUTCOME MEASURES: Kaplan-Meier survival estimates were calculated and compared.

RESULTS: Survival estimates showed a statistically significant reduction in overall postoperative mortality following the introduction of EVAR (P < .03). The 90-day overall mortality rate was reduced from 54.8% to 27.7% during the second period (P < .01). Survival of patients older than 75.5 years was especially improved (75% vs 28.6%; P < .01). There was a parallel pattern of significant reduction of the mortality rate after OGR to 29% (P < .03).

CONCLUSION: Offering both EVAR and OGR to patients with rAAA leads to significant improvements in postoperative survival.