Complete replacement of open repair for ruptured abdominal aortic aneurysms by emergent endovascular repair: a 7-year experience from a single centre in mainland China

Objective To evaluate the safety and effectiveness of endovascular aortic repair (EVAR) used in ruptured abdominal aortic aneurysm (AAA), and to discuss the possibility for replacement of the traditional open surgery with EVAR in this disease. Methods Cases of EVAR on noninfected ruptured AAA over recent 7-year period were reviewed, in which the treatment strategies evolved from "EVAR/OPEN" approach (2009.1~2014.3) to "EVAR-PRIMARY" approach (2014.4~2016.7) were compared. Results Over this 7 years, 80 patients with truly-ruptured AAA were admitted in the emergency room of Zhongshan hospital from March 2009 to July 2016, among which 27 (33.8%) died preoperatively. Twenty six cases (15 EVARs and 11 OPENs) were treated during "EVAR/OPEN" period, and thereafter during the "EVAR-PRIMARY" period all the 27 cases were treated by EVAR. The 30-day mortality rate was 26.9% (26.7% for EVAR and 27.3% for OPEN) for the "EVAR/OPEN" period and 25.9% for the "EVAR-PRIMARY" period (P=0.93). For all patients, preoperative hemodynamic stability (OR=0.22, 95%CI 0.06~0.85, P=0.03) was found associated with lower mortality rate. As for EVAR patients, local anesthesia (OR=0.18, 95%CI 0.04~0.82, P=0.03) were found associated with lower mortality rate, comparing with general anesthesia. However, any association between hemodynamic status and the prognosis in both procedures were not found. Conclusions The "EVAR-PRIMARY" approach has allowed EVAR to be used in nearly all the ruptured AAA with similar mortality comparing with "EVAR/OPEN" approach. Key words: Abdominal aortic aneurysm, rupture; Endovascular aortic repair; Open surgery