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Paradigm Shift in Ruptured AAA (RAAA) Management; Twelve years experience in a tertiary referral centre of Endovascular repair of RAAA(REVAR) vs open repair (OR).
Sherif Sultan, MD FRCS FASC EBQS Vasc, Ala Elhelali, MSc, Niamh Hynes, MD MRCS MMSc endo.
Western Vascular Institute, Galway, Ireland.
Out of 683 AAA operated upon, 79 patients presented with RAAA over 12 years.
During 20th century 95% of all AAA were done surgically. However during 21st century 80% of AAA is done endovascularly. Mean Annual number of OR dropped from 19+/-3.6 to 18+/-7.8 ,P<0.845, however Mean Annual number of EVARs had rocketed to 26+/-6.1 P<0.006 .
Overall number of AAA repairs has increased by 65% over twelve years period and number of EVAR has increased by 80% but the absolute number of RAAA had declined.
Total Emergency mortality rate decreased from 64% to 28.2%. Low Mortality Rate of 16%for REVAR Vs 32%in OR, in addition to a significant reduction in Myocardial infarction (p=0.033),massive transfusion>8units(p=0.028, respiratory failure (p=0.039), length of total (p=0.042) and ICU stay (0.008) is due to introduction of an REVAR Programme which constitutes screening for prevention with early intervention and REVAR for rupture which has an absolute perioperative mortality reduction of 49% over OR.
No patient survived more than 4 years post rupture. The. Majority of deaths were non-aneurysm related. A 18 months aneurysm related survival was 48.1% vs non-aneurysm survival 46.3% (p=0.786, h=0.93, 95%CI:0.55-1.58).
Paramillenium and Contemporary Trends in AAA Management have shown Increased Elective EVAR which increased the mortality advantage in favour of REVAR and it should be Gold standard for RAAA.
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