Clinical Presentation, Operative Management And Long-term Outcome Of Rupture Following Previous Abdominal Aortic Aneurysm Repair
Indrani Sen1, Irina Kanzafarova2, Jennifer Yonkus1, Bernardo Mendes1, Jill Colglazier1, Fahad Shuja1, Manju Kalra1, Randall DeMartino1, Todd Rasmussen1.
1Mayo clinic, Rochester, MN, USA, 2Mayo clinic, ROCHESTER, MN, USA.
Introduction Late abdominal aortic aneurysm (AAA) rupture (LAR) following open or endovascular repair is uncommon but life-threatening. This study aims to characterize presentation trends, intervention and survival following LAR. Methods Single-center, retrospective study of patients treated for LAR from 2000-2020 was conducted. Endpoints were 30-day mortality, major post-operative complication, and survival. We compared outcomes between LAR managed with endovascular (Group I) versus OR. (Group II). Results Of 390 patients with infrarenal aortic rupture, 40 (10%) had a prior aortic repair and comprise the LAR cohort (34 males, mean age 78 years, initial EVAR in 29, initial OR in 11). LAR occurred despite re-intervention in 13 (44%), endoleaks were Type I in 21(72%), Type III in 3(10%) and Type II in 2 (3%); 10 (29%) were lost to follow up. LAR after prior OR was secondary to ruptured paraanastomotic pseudoaneurysms. This was managed with endovascular salvage in 9. Time to LAR was shorter following prior EVAR compared to OR (6+ 4 vs. 12+ 4 years respectively, p=0.003) Treatment for LAR was endovascular in 27 patients (67%; Group I) and OR in 14 (35%, Group II). Endovascular management more frequent in the latter half. (Figure 1). In Group I, fenestrated repair was used in 7 (26%) patients, salvage in the rest was feasible with EVAR, aortic cuffs or limb extensions. Incidence of free rupture, time to treatment, 30-day mortality and disposition and was similar between groups. Those in Group I had less blood loss (660 vs 3000 mL, p<0.001) and need for dialysis (0% vs 33%, p<0.001) than those in Group II. Median follow up 20 months (IQR 6-45). The 1, 3 and 5-year survival was 76%, 52% and 41%, respectively and similar between groups (28 vs 22 months, p=0.92). Conclusion Late aortic rupture in the years following AAA repair is increasingly common, likely driven by the frequency of EVAR. Most late aortic ruptures, including those following previous open repair, can be now be salvaged with endovascular techniques with lower morbidity and mortality. 
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