R Barnes1, X Kassianides, H Barakat, E Mironska, R Lakshminarayan, I C Chetter. 1. Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, Hull, HU3 2JZ, UK, rachelbarnes00@hotmail.com.
Abstract
OBJECTIVES: Perioperative mortality of open repair of ruptured abdominal aortic aneurysms (rAAA) remains unacceptably high: 30-day mortality ≈ 40 %. This study aimed to assess, quantify, and determine the consequences of anatomic suitability for endovascular repair of rAAA. DESIGN: A retrospective analysis of the prospectively maintained database identified patients with rAAA. METHODS: Preoperative CT scans were assessed for anatomic suitability for emergency EVAR and precluding factors recorded. Demographic information was collected and analysed for all patients. RESULTS: A total of 141 patients underwent open surgical repair of rAAA. Forty-six patients had preoperative CT scans suitable for reconstruction. Morphological measurements indicated that 41 % would have been anatomically suitable for EVAR. Suitability was associated with lower mortality rates than unsuitability: 0, 11, and 20 % (24 h, 30 days, and 1 year respectively) versus 11, 33, and 59 % (statistically significant at 1 year; p = 0.02). The groups were comparable excepting diabetes incidence, which was higher in those suitable for EVAR (p = 0.003). CONCLUSIONS: A minority of patients with ruptured AAA are anatomically suitable for EVAR. Anatomical suitability appears to identify patients at low risk from open surgery. Whether this is due to technically less demanding open surgery is unknown. This may be resolved by the IMPROVE trial results, which are eagerly awaited.
OBJECTIVES: Perioperative mortality of open repair of ruptured abdominal aortic aneurysms (rAAA) remains unacceptably high: 30-day mortality ≈ 40 %. This study aimed to assess, quantify, and determine the consequences of anatomic suitability for endovascular repair of rAAA. DESIGN: A retrospective analysis of the prospectively maintained database identified patients with rAAA. METHODS: Preoperative CT scans were assessed for anatomic suitability for emergency EVAR and precluding factors recorded. Demographic information was collected and analysed for all patients. RESULTS: A total of 141 patients underwent open surgical repair of rAAA. Forty-six patients had preoperative CT scans suitable for reconstruction. Morphological measurements indicated that 41 % would have been anatomically suitable for EVAR. Suitability was associated with lower mortality rates than unsuitability: 0, 11, and 20 % (24 h, 30 days, and 1 year respectively) versus 11, 33, and 59 % (statistically significant at 1 year; p = 0.02). The groups were comparable excepting diabetes incidence, which was higher in those suitable for EVAR (p = 0.003). CONCLUSIONS: A minority of patients with ruptured AAA are anatomically suitable for EVAR. Anatomical suitability appears to identify patients at low risk from open surgery. Whether this is due to technically less demanding open surgery is unknown. This may be resolved by the IMPROVE trial results, which are eagerly awaited.
Authors: Elliot L Chaikof; David C Brewster; Ronald L Dalman; Michel S Makaroun; Karl A Illig; Gregorio A Sicard; Carlos H Timaran; Gilbert R Upchurch; Frank J Veith Journal: J Vasc Surg Date: 2009-10 Impact factor: 4.268
Authors: Daniel F G Rose; Ian R Davidson; Robert J Hinchliffe; Simon C Whitaker; Roger H Gregson; Shane T MacSweeney; Brian R Hopkinson Journal: J Endovasc Ther Date: 2003-06 Impact factor: 3.487