AAA Rupture Outcomes with and without Prior EVAR
Robert Moskowitz, DO, Paul Anain, MD.
Sisters of Charity Hospital, Buffalo, NY, USA.
Objective: Despite advances in screening of abdominal aortic aneurysm (AAA), a significant number of patients continue to present to the hospital with ruptured AAA. The purpose of our study is to analyze patient presentation and outcomes of ruptured AAA in our hospital system as well as the potential effects of inter-campus transfer of patients within a large multi-facility healthcare system.
Methods: A retrospective review from January 2006 until December of 2016 of patients treated for ruptured AAA within our healthcare system was performed. Demographics, presentation, and 30-day all-cause mortality rates were compared. Presence of hypotension and transfer status were also examined for effects on outcomes.
Results: A total of 81 patients met inclusion criteria. Patients were split into 3 groups; group 1 (n=20) had prior EVAR, group 2 (n=6) had prior open aneurysm repair and group 3 (n=55) did not have prior repair. Mortality rates were 25% in group 1, 17% in group 2 and 36% in group 3, however differences were not statistically significant. There were no significant differences in demographics, aneurysm size, comorbidities, presentation or transfer status. There was no association between transfer status and mortality, however patients presenting with hypotension (SBP<90 mmHg) were more likely to have mortality (24% versus 61%).
Conclusion: There were no significant differences in mortality between the three groups. Additionally this study confirms that protocol driven inter-hospital transfer of patients with ruptured AAA is a safe and effective means of utilizing limited hospital resources. Further study is necessary to elucidate the best method of identifying and managing patients at risk of rupture, especially following previous EVAR.
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