SCVS - Outcomes After Endovascular Aortic Aneurysm Repair (EVAR) Compared With Open Surgical Repair For Ruptured Abdominal Aortic Aneurysms (rAAA) In A Contemporary National Registry

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Outcomes After Endovascular Aortic Aneurysm Repair (EVAR) Compared With Open Surgical Repair For Ruptured Abdominal Aortic Aneurysms (rAAA) In A Contemporary National Registry
Robert Chang, MD^¹, Karen Quirk, MD^², Faith Anthony, MA^³, Mary Lou Kiley, MBA^³, Christopher Ake, PhD^³, Bradley Hill, MD^⁴, Rishad Faruqi, MD^⁴, Thomas Rehring, MD^⁵, Homayon Hajarizadeh, MD^⁶, Robert Hye, MD^³.
^¹The Permanente Medical Group, South San Francisco, CA, USA, ^²University of California, San Diego, San Diego, CA, USA, ^³Southern California Permanente Medical Group, San Diego, CA, USA, ^⁴The Permanente Medical Group, Santa Clara, CA, USA, ^⁵Colorado Permanente Medical Group, Denver, CO, USA, ^⁶Northwest Permanente Medical Group, Clackamas, OR, USA.

OBJECTIVES: Recent studies report conflicting evidence about the utility and survival advantage of EVAR over traditional open surgical repair for ruptured abdominal aortic aneurysms (rAAAs). In this study we examine the short-term outcomes of both methods in a national registry.
METHODS: All open and EVAR repairs from 1/1/2010 through12/31/2011 recorded in a national registry of a community-based integrated health care system were retrospectively reviewed. Cases of rAAA were further analyzed. Mortality rates at 30 days and at 1 year for open repair and EVAR were compared via chi-square test or Fisher’s Exact Test. Rates of reinterventions and overall complications were calculated for each group.
RESULTS: During the two year study period, 1380 AAA repairs were performed, 358 by open repair and 1022 by EVAR. There were 124 rAAA cases, of which 90 were repaired open and 34 by EVAR. 12 of the 34 ruptures repaired by EVAR were performed outside of instructions-for-use guidelines. 30 day mortality was significantly higher in the open rupture group (45.6%) compared with the EVAR group (17.7%, p=0.004). One year survival was 61.8% in the EVAR group and 50.0% in the open surgical group, but this did not reach significance, (p=0.24). There were more perioperative complications seen in the open surgery group, 40.0% vs. 20.6%, (p=0.04). Mean length of stay and reintervention rates did not differ significantly between the ruptured open and EVAR groups (11.1 vs. 7.9 days, p=0.74; 8.9% vs.14.7%, p=0.34, respectively).
CONCLUSIONS: In a contemporary national registry experience, endovascular repair of rAAA is associated with improved 30 day survival but not one year survival compared with open repair with lower short-term complication rates but similar reintervention rates. Most rAAAs continue to be repaired with an open technique. While the short term results of rAAA repair with EVAR are excellent, more study is needed to determine optimal treatment options and predictors of long-term survival.

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