开放或血管腔内修复腹主动脉瘤21178例的荟萃分析

目的已有几个研究比较择期开放和血管腔内方法治疗腹主动脉瘤的预后，而结果并不一致。方法进行随机效应meta分析对手术结果、术后并发症、30天死亡率和术后患者长期存活率进行比较。以优势比（ORs）、加权平均差异（WMDs）或者log风险比（HRs）等合适的方法来比较事件终点。结果42个研究共21178例患者（开放10855例；血管腔内10323例）被纳入。在择期手术组（20715例），血管腔内方法的重症监护时间较短（WMD-36h；P〈0．001），术后总住院时间亦较短（WMD一5．4d；P〈0．001）。心脏并发症（OR1．76；P=0．002）和呼吸系统并发症（OR4．01；P〈0．001）在开放手术后更常见。在血管腔内组，30天死亡率较低（OR0．46；P〈0．001）。血管腔内手术的远期动脉瘤相关死亡率也较低（HR0．39；P〈0．001）。对于破裂性腹主动脉瘤（463例），这种微创手术的重症监护时间较短（WMD-100．4h；P=-0．005），30天死亡率也明显为低（OR0．45；P=0．005）。结论血管腔内修复腹主动脉瘤在降低术后不良事件和30天死亡率等方面成效显著。对于更远期，其动脉瘤相关死亡率也明显降低，但总体死亡率没有降低。     

腹主动脉瘤开腹手术与腔内治疗的比较

目的：比较腹主动脉瘤腔内修复术与开放手术的疗效。方法：对35例肾下型腹主动脉瘤患者分别进行开放手术（21例）与腔内修复术（14例）治疗,比较两组术前评估、手术、围手术期及术后随访情况。结果：腔内修复组年龄较高（P〈0.05）,手术时间、术中出血量、输血量较开腹手术低（P〈0.01）,所需营养支持、监护、卧床时间短（P〈0.01）,围手术期并发症发生率低（P〈0.05）,但远期并发症发生率较高（P〈0.05）。结论：腹主动脉瘤腔内支架治疗较为安全,创伤更小,患者恢复速度较快,适合于高龄及合并症较多的患者。传统开放手术适于年轻、合并症少及无法行腔内修复术的患者。     

腹主动脉瘤腔内修复与开放手术疗效比较

目的 比较腹主动脉瘤开放手术和腔内治疗的效果.方法 对2002年1月至2007年7月收治的223例分别行开放手术和腔内修复的腹主动脉瘤患者进行网顾性分析.手术组141例,男性118例,女性23例;腔内治疗组82例,男性66例,女性16例.对手术相关情况、围手术期并发症发生率、病死率、随访中并发症发生率等进行对比分析.结果 腔内修复组手术时间、术中出血量、输血量均少于开放手术组(P<0.01),围手术期并发症两组无显著差异(P>0.05),SF-36量表评估显示术后6个月开放手术组优于腔内治疗组,术后2年生存率两组无明显差异(P>0.05),但腔内修复组并发症发生率高于开放手术组(P<0.01).住院费用腔内修复组明显高于开放手术组(P<0.01).结论 腹主动脉瘤腔内修复具有手术时间短、微创的特点,但具有较高的远期并发症,开放手术组6个月健康生存质量优于腔内修复组.     

腹主动脉瘤传统开放手术与腔内修复术疗效比较

比较传统开放手术与腔内修复术治疗腹主动脉瘤的临床疗效。80例腹主动脉瘤患者分为腔内修复组和开放手术组,对比分析两组患者的术前、术中以及术后情况。腔内修复组的术中出血量、术中输血量、手术时间、重症监护时间、住院时间均明显少于开放手术组(P0.05),术后并发症发生情况两组差异无统计学意义(P0.05)。与传统开放手术相比,腔内修复术治疗腹主动脉瘤创伤小、恢复快等优点。     

腔内修复与开放手术治疗腹主动脉瘤的疗效比较

目的 比较腹主动脉瘤开放手术和腔内治疗的效果.方法 对223例分别行开放手术和腔内修复的腹主动脉瘤患者的临床资料进行回顾性分析,对手术相关情况、围手术期及随访中并发症发生率、生存率、生存质量以及与住院相关的费用进行了对比分析.结果 腔内修复组手术时间、术中出血量、输血量均少于开放手术组(P<0.01);两组围手术期并发症比较无显著差异(P>0.05);SF-36量表评估显示术后6个月开放手术组生活质量优于腔内治疗组,两组术后2年生存率比较无显著差异(P>0.05),但腔内修复组并发症发生率高于开放手术组(P<0.01).住院费用腔内修复组明显高于开放手术组(P<0.01).结论 腹主动脉瘤腔内修复具有手术时间短、微创的特点,但具有较高的远期并发症;开放手术组术后6个月健康生存质量优于腔内修复组.     

腹主动脉瘤腔内修复与开放手术疗效初探

目的 比较腹主动脉瘤开放手术与腔内治疗的效果.方法 对42例分别行开放手术和腔内修复的腹主动脉瘤患者的手术相关情况、围手术期并发症发生率、病死率、随访情况以及相关的费用进行对比分析.结果 腔内修复组手术时间、术中出血量、输血量均少于开放手术组(P<0.01),两组围手术期并发症差异无统计学意义(P>0.05),两组术后2年生存率差异无统计学意义(P>0.05),但腔内修复组术后远期并发症发生率高于开放手术组(P<0.01).住院费用腔内修复组明显高于开放手术组(P<0.01).结论 腹主动脉瘤腔内修复术具有手术时间短、微创的特点,但具有较高的远期并发症,开放手术组6个月生存质量优于腔内修复组.     

腔内修复术与开放手术治疗腹主动脉瘤的对比分析

目的 对比分析传统开放手术与血管腔内修复术治疗腹主动脉瘤的疗效.方法 回顾性分析我科2009年至2012年经外科治疗的43例肾动脉下腹主动脉瘤患者的临床资料,行腔内治疗患者25例,行传统手术的18例,对比分析两组患者术前、术中情况,术后并发症及6个月内死亡情况.结果 两组患者在手术时间、术中失血及输血量方面,两组差异均有统计学意义（t值分别为8.377,5.124,5.043,P均＜0.001）;术后30d内并发症比较,差异有统计学意义（X2=0.09,P＜0.05）;术后6个月内死亡率比较,差异无统计学意义（x2=4.21,P＞0.05）.结论 血管腔内修复术比传统手术创伤小,手术时间短,术中失血及输血量少,术后短期并发症发生率低,但中远期死亡率无明显差别.     

腹主动脉瘤开放手术与腔内修复术中期结果比较的单中心前瞻性研究

目的 比较腹主动脉瘤开放手术与腔内修复的治疗效果.方法 2009年1月到2011年1月随机入组既符合开放手术又符合腔内修复指征的腹主动脉瘤患者84例,分别行开放手术及腔内修复.其中腔内修复组48例,男性42例(87.5％),女性6例(12.5％);年龄50～83岁,平均70.8岁.开放手术组36例,其中男性31例(86.1％),女性5例(13.9％);年龄50～80岁,平均67.4岁.对围手术期及随访结果进行对比分析.结果 两组手术时间(t=9.863,P=0.000)、术中出血量(t=4.647,P=0.000)、术中输血量(t=3.334,P=0.002)和住院时间(t=2.327,P=0.022)、住院费用(t =2.314,P=0.023)差异有统计学意义.随访3～6个月,两组围手术期并发症发生率(x2=0.480,P=0.488)、术后3个月并发症发生率(x2=0.664,P=0.415)及病死率(P=0.429)、术后6个月并发症发生率(x2 =0.128,P=0.720)差异无统计学意义.结论 腹主动脉瘤腔内修复在手术时间、出血量、输血量、住院时间等方面优于开放手术,但有较高的住院费用.围手术期及术后随访两组的并发症发生率无差异,生存率及远期并发症发生率比较尚需更长时间随访及更大的样本量.     

腹主动脉瘤开腹手术与腔内介入治疗的比较

目的　评价腹主动脉瘤腔内介入治疗技术的可行性。　方法　对我院采用传统开腹手术的 32例和腔内介入治疗的 2 0例腹主动脉瘤患者的临床资料进行了回顾性分析。比较 2组患者治疗前的身体状况、手术所用时间、术中出血量、术后恢复状况和并发症发生情况。　结果　 2组患者的性别、年龄分布、相关疾病、麻醉危险分级、动脉瘤分型及瘤体大小、手术成功率和病死率等差异无显著性意义 (P >0 0 5 ) ;腔内介入治疗组患者手术时间、术中出血量、术后ICU护理时间、饮食恢复时间、开始下地活动时间及住院时间均较传统开腹手术组患者明显减少 ,差异有显著性意义 (P <0 0 5 ) ,但术后并发症的发生率高于传统开腹手术组。术后并发症以内漏为主 ,并发症的发生与介入技术操作有关。　结论　腹主动脉瘤腔内介入治疗较传统开腹手术治疗具有创伤小、恢复快、住院时间短的优点 ,尤其适合不能耐受开腹手术的患者。但对该技术可能带来的并发症有待进一步探讨。     

腔内修复术与开放手术治疗急性Stanford B型主动脉夹层疗效评价

目的系统评价腔内修复术（覆膜支架置入术）与开放手术治疗急性Stanford B型主动脉夹层的有效性与安全性。方法计算机检索1991年1月至2013年1月期间收录在CNKI、万方、维普、Cochrane图书馆临床对照试验中心注册库、OVID、Pubmed Medline、EBSCO、EMBASE、Springer Link、Science Direct等数据库中关于主动脉腔内修复术和开放手术治疗急性StanfordB型主动脉夹层的临床对照试验文献,用RevMan5.1软件对符合标准的临床试验数据进行分析。结果8个临床试验共纳入5618例急性B型主动脉夹层患者,腔内修复术组与开放手术组治疗后30d死亡率差异有统计学意义,腔内修复组明显优于开放手术组[OR=0.55,95％CI（0.46～0.65）,P〈0.00001]。另外,中风（OR=0.57,95％C1（0.39～0184）,P=0.005]、呼吸衰竭[OR=0.64,95％CI（0.53～0.78）,P〈0.00001]和心脏并发症[OR=O.49,95％CI（0.38～0.64）,P〈0.00001]的发生率差异均有统计学意义,腔内修复组优于开放手术组;截瘫[OR=I.30,95％C1（0.82～2.05）,P=0.26]和急性肾功能衰竭[OR=0.86,95％CI（0.41～1.80）,P=0.69]的发生率差异无统计学意义。结论腔内修复术可以作为治疗急性StanfordB型主动脉夹层的首选治疗方法。     

Cost of endovascular versus open surgical repair of abdominal aortic aneurysms

BACKGROUND: Endovascular repair of abdominal aortic aneurysms (AAA) is a new minimally invasive method of aneurysm exclusion that has been adopted with increasing enthusiasm, and with acceptable clinical results. It is important, however, to assess new health-care technologies in terms of their economic as well as their clinical impact. The aim of the present study was to compare the total treatment costs for endovascular (EVR) and open surgical repair (OSR) for AAA. METHODS: A retrospective review of patient hospital and outpatient records for 62 patients undergoing either EVR (n = 31) or OSR (n = 31) was carried out between June 1996 and October 1999. Resource utilization was determined by a combination of patient clinical and financial accounting data. Costs were determined for preoperative assessment, inpatient hospital stay, cost of readmissions and follow up, and predicted lifetime follow-up costs. RESULTS: The two groups were well matched, with no significant difference with respect to age, gender, maximum aneurysm diameter or comorbid factors. Endovascular treatment resulted in a shorter intensive care unit (ICU) and hospital stay (mean: 0.07 vs 2.9 days, P < 0.001; mean: 6.0 vs 13.4 days, P < 0.001; respectively) and fewer postoperative complications (P = 0.003). The cost of hospitalization was less for EVR ($7614 vs $15092, P < 0.001), but this was offset by the more costly vascular prosthesis ($10284 vs $686). Costs were higher for the EVR group for preoperative assessment ($2328 vs $1540, P < 0.001) and follow up ($1284 vs $70, P < 0.001). Lifelong follow up could be expected to cost an additional $4120 per patient after EVR. Total lifetime treatment costs including costs associated with readmission for procedure-related complications were higher for EVR ($26909 vs $17650). CONCLUSION: Treatment costs for endovascular repair are higher than conventional surgical repair due to the cost of the vascular prosthesis and the greater requirement for radiological imaging studies.     

Durability of benefits of endovascular versus conventional abdominal aortic aneurysm repair

PURPOSE: Endovascular abdominal aortic aneurysm (AAA) repair is reported to result in less initial patient morbidity and a shorter hospital length of stay (LOS) when compared with conventional AAA repair. We sought to examine the durability of this result during the intermediate follow-up interval. METHODS: The records of all admissions for all patients who underwent AAA repair during a 26-month interval were reviewed. RESULTS: Three hundred thirty-seven (337) patients underwent procedures to repair AAAs (163 open and 174 endovascular). Endovascular procedures were performed with a variety of devices (Talent, 108; Ancure, 36; AneuRx, 26; Zenith, 2; and Cordis, 2) and configurations (141 bifurcated and 33 aortomonoiliac). The mean follow-up period was 10.6 months (endovascular repair) and 12.3 months (open repair). LOS did not significantly vary by device (P =.24 to P =.92) or configuration (P =.24). The initial median LOS for procedures was significantly shorter (P =.009) for endovascular repairs (5 days) than for open procedures (8 days). However, the patients who underwent endovascular repair were more likely to be readmitted during the follow-up interval when compared with patients who underwent open procedure. The readmission-free survival rate after AAA repair at 12 months was 95% for patients for open AAA repair versus 71% for patients for endovascular repair (P <.001). If the total hospital days were compared, including the initial and all subsequent AAA-related admissions, there was no significant difference for mean LOS for patients who underwent endovascular versus open AAA procedures (11 days versus 13.6 days; P =.21). The patients for endovascular AAA repair most commonly needed readmission for treatment of endoleak (n = 31), wound infection (n = 12), and graft limb thrombosis (n = 9). Although women had similar LOS to men for endovascular repair (P =.44), they had longer initial LOS for open AAA repair (15 versus 10 days; P =.03). After endovascular repair, women were more likely than men to be readmitted by 12 months (51% versus 71% readmission-free survival rate; P =.03) and they had longer LOS on readmission (13.2 versus 5.2 days; P =.006). No gender differences were identified for patients after open AAA repair regarding readmission-free survival rate (P =.09) or LOS on readmission (P =.98). CONCLUSION: Although initial LOS was shorter for the patients who underwent endovascular as compared with conventional AAA repair, this advantage was lost during the follow-up interval because of frequent readmission for the treatment of procedure-related complications, chiefly endoleak. These readmissions frequently involved the performance of additional invasive procedures. Gender differences existed regarding LOS and the likelihood of complications after open and endovascular AAA repair.     

腹主动脉瘤形态学特点及临床意义

目的了解腹主动脉瘤的形态学特点对腔内修复术(EVR)治疗方法的影响.方法应用螺旋CT血管造影检测了30例腹主动脉瘤并收集解剖学数据.结果动脉瘤平均最大直径5.9cm(4.0～12.2cm),腹主动脉瘤直径与瘤颈的角度呈正相关(r=0.47,P＜0.05);与瘤颈长度呈负相关(r=-0.41,P＜0.05).本组病例中有12例(40%)符合EVR要求的解剖条件,18例不适合EVR手术,其中16例(53.3%)因瘤颈角度过大(平均88.8°,范围70°～110°,其中4例合并髂总动脉瘤),1例(3.3%)因瘤颈过短,另1例(3.3%)单侧髂总动脉闭塞伴瘤颈附壁血栓.结论影响腹主动脉瘤EVR手术最主要的单一因素是瘤颈角度过大.这是与欧美腹主动脉瘤病例不同的形态学特点.     

Abdominal aortic aneurysm repair in octogenarians: myth or reality?

AIM: We studied the thirty-day mortality and morbidity rate to assess the value of conventional open repair vs endovascular aortic repair (EVAR) in an elderly population presenting with a ruptured, symptomatic or asymptomatic abdominal aortic aneurysm (AAA) undergoing emergency, urgent or elective repair. METHODS: During the period from January 2004 to May 2007, 329 consecutive patients were treated for AAA in our Department. Among these, 81 (24.6%) were aged >80 years (mean age 83.6, range 80-95 years). These older patients were divided into groups according to their clinical presentation: ruptured AAA group (rAAA) - 22 cases (4 emergency EVAR, 18 emergency open repair); symptomatic non-ruptured AAA group (sAAA) - 15 cases (11 urgent EVAR, 4 urgent open repair); asymptomatic AAA group (asAAA) - 44 cases (32 elective EVAR, 12 elective open repair). The main outcome measures were 30-day mortality and 30-day morbidity rate. RESULTS: The mortality rate following open surgery vs EVAR was 66.6% vs 50% (P=NS) in the rAAA group, 25% vs 0% (P=NS) in the sAAA group, and 9% vs 3.2% (P=NS) in the asAAA group. When comparing postoperative morbidities in the octogenarians, 3 of the patients that received EVAR (6.4%) and 15 of those that received open repair (48.4%) had a severe complication (P<0.01). CONCLUSION: The introduction of EVAR has considerably changed the balance of risks and benefits for AAA treatment. Our study confirms the high mortality rate for octogenarians with rAAA and haemodynamic instability, and supports the value of an active EVAR approach for octogenarians with AAA to prevent rupture. Moreover, the introduction of endovascular techniques as part of an overall treatment algorithm for ruptured AAAs appears to be potentially associated with improved outcomes in terms of mortality and morbidity as compared to open surgical repairs alone.     

Rupture of abdominal aortic aneurysm: concurrent comparison of outcome of those occurring after endovascular repair versus those occurring without previous treatment in an 11-year single-center experience

OBJECTIVE: The purpose of this single-center study was to compare findings at presentation and surgical outcome in patients in whom abdominal aortic aneurysms (AAAs) ruptured after endovascular repair and patients in whom AAAs ruptured before any treatment, over a defined period. METHODS: From May 1992 to September 2003, 1043 patients underwent elective repair of intact infrarenal AAAs. Endovascular repair was performed in 609 patients, and open repair in 434 patients. Eighteen of 609 patients (3%) who underwent endovascular AAA repair required treatment because of rupture of the aneurysm after a mean of 29 months (group 1). During the same 11-year period, another 91 patients without previous treatment required urgent repair of a ruptured AAA (group 2). Rupture was diagnosed at contrast material-enhanced computed tomography or by presence of extramural extravasation of blood at open repair. Except for a higher incidence of women in group 2, patients in both groups were similar with regard to demographics and clinical characteristics but differed in findings at presentation. Eight patients in group 1 had a known endoleak before AAA rupture, whereas contrast-enhanced computed tomography, performed in 15 patients at presentation, demonstrated an endoleak in all. Hypotension (systolic blood pressure <100 mm Hg) was noted at presentation in 4 of 18 patients (22%) in group 1 and 76 of 91 patients (84%) in group 2. All patients underwent open repair via a transperitoneal approach, except for 4 patients in group 1 and 3 patients in group 2 who underwent endovascular repair of ruptured AAAs. RESULTS: The proportion of patients with hypotension at presentation in group 1 (4 of 18) was significantly less than in group 2 (76 of 91; P < .01). The difference in perioperative (30 day) mortality rate in group 1 (3 of 18; 16.6%) compared with group 2 (49 of 91; 53.8%) was also significant (P < .01). The outcome in group 1 was therefore superior to that in group 2. CONCLUSIONS: This study confirms that endovascular AAA repair complicated by endoleak does not prevent rupture. The data suggest, however, that rupture, when it occurs in these circumstances, may not be accompanied by such major hemodynamic changes and high mortality as rupture of an untreated AAA. Further long-term follow-up and analysis in a larger group of patients are required to confirm the apparent intermediate level of protection afforded by failed endovascular repair, which does not prevent rupture but enhances survival after operation to treat rupture, possibly by ameliorating the hemodynamic changes associated with the rupture process.     

Should the role of EVAR be re-evaluated in light of the 10 year results of EVAR-1?

EVAR-1 published its 10 year results in 2010. The principal finding of the study was that the endovascular group (EVR) had a significant reduction in early aneurysm related mortality compared to open surgery (OR), but the benefit was lost by the end of the study (adjusted hazard ratio [HR], 0.92; 95% confidence interval [CI] 0.57-1.49; P=0.73). By the end of follow-up, there was no significant difference between the OR and EVR group in terms of death from any cause (HR 1.03; 95% CI 0.86-1.23; P=0.72). Despite these findings the uptake of EVR continues to increase. EVR is driving improved surgical outcomes in elective abdominal aortic aneurysm (AAA) surgery, and may yet establish itself as an essential tool in the emergency setting. Elective AAA mortality may be reducing in the U.K. as a consequence of broader application of EVR. This article presents and examines the EVAR-1 data and reports the additional wealth of evidence supporting EVR from prospective registries. It proposes that EVR should be re-evaluated, but not as a consequence of the long-term EVAR-1 results. Clinicians' expertise, understanding and the technology of EVR have progressed significantly since the establishment of the EVAR-1 trial, such that the results, though valuable, may not translate to modern practice. It is essential to maintain excellence in vascular surgery and the evidence-base now demonstrates that best practice in AAA management is in specialist vascular centres, performing high volume surgery offering EVR to all patients who are morphologically suitable.     

An analysis of standard open and endovascular surgical repair of abdominal aortic aneurysms in octogenarians

While elective open abdominal aortic aneurysm (AAA) repair has been shown to be safe in selected octogenarians, very little is known about the role of endovascular AAA exclusion in this high-risk cohort. A retrospective review of our vascular surgical registry from January 1996 to December 2001 revealed 51 octogenarians that underwent infrarenal AAA repair. Since 1999 all octogenarians who presented for AAA repair were evaluated for preferential endovascular stent graft placement. Over the 6-year period, 35 patients underwent standard open repair while 16 patients were found to be anatomic candidates for and were treated with an endovascular stent graft. Hospital and office charts were reviewed to compare the endovascular cohort to the standard open cohort. Factors considered included patient comorbidities, perioperative data, and operative outcomes. Statistical analysis was done using Wilcoxon rank sum test and Fisher exact test. The median age for the entire group was 83 years. There were 11 females in the open group and 1 female in the endovascular group. There were no statistically significant differences in preoperative patient comorbidities between groups. Total mortality for the entire series was 11.8 per cent but this included 5 ruptured AAAs, all of which patients died, and 11 additional AAAs that were symptomatic, of which 1 patient died. Total nonruptured mortality for the entire series was 2.2 per cent (0% for the endo-group and 3.3% for the open group). There were statistically significant differences between the endovascular versus the open groups when comparing aneurysm diameter (5.6 cm vs. 6.2 cm; P = 0.016), estimated blood loss (225 cc vs. 2100 cc; P < 0.001), ICU days (0 vs. 3; P < 0.001), length of hospital stay (2 days vs. 12 days; P < 0.001), and patients with blood transfusions (1 vs. 27; P < 0.001). When comparing postoperative morbidities, 4 of the endovascular patients (25%) and 25 of the open patients (68.6%) had a complication (P = 0.006). In conclusion, endovascular stent graft treatment of nonruptured infrarenal AAAs in octogenarians led to significantly better outcomes and should probably be considered the preferred treatment whenever anatomically appropriate. Endovascular exclusion of ruptured AAAs may potentially improve future outcomes in this high-risk group.     

Quality of life before and after endovascular and retroperitoneal abdominal aortic aneurysm repair

PURPOSE: This study was undertaken to evaluate changes in quality of life and to compare conventional outcomes in patients undergoing endovascular and open retroperitoneal abdominal aortic aneurysm (AAA) repair. METHODS: Between October 2000 and May 2003, 129 patients underwent elective AAA repair, endovascular repair in 22 patients and open retroperitoneal repair in 107 patients. The Short-Form Health Survey, 12 items (SF-12) was administered preoperatively and at 3 weeks, 4 months, and 1 year after discharge. Quality of life, hospital and intensive care unit stay, perioperative complications, discharge disposition, readmission, and hospital cost were statistically evaluated. RESULTS: For the total group, significant differences were observed for both Physical Component Summary scores (P<.001) and Mental Component Summary scores (P=.001) between time points. There were no significant differences for either Component Summary score between open and endovascular procedures for any time period. Number of weeks required to return to baseline functional status was similar after either open or endovascular repair (7.22 vs 5.47 weeks, respectively; P=.09). Mean hospital and intensive care unit stay was 4.4 and 1 days, respectively, for open repair versus 1.9 and 0 days, respectively, for endovascular repair (P<.0001). No significant difference between groups was observed in terms of perioperative complications, discharge disposition, or hospital readmission (P> or =.54). Mean total hospital cost for endovascular repair was 1.60 times that for open repair (mean difference, $11,662; P<.0001; 95% confidence interval, $17,799-$5525). CONCLUSIONS: Hospital stay is significantly shorter after endovascular AAA repair. However, hospital cost is almost twice that for open retroperitoneal repair. Perioperative complications, discharge disposition, and hospital readmission are not statistically different between the two groups. Effect on health-related quality of life is similar after either open retroperitoneal or endovascular AAA repair.     

An intention-to-treat by endovascular repair policy may reduce overall mortality in ruptured abdominal aortic aneurysm

OBJECTIVE: The use of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) has been restricted to a small number of specialized units on a selected group of patients. The aim of this study is to assess if the overall mortality in these patients with ruptured AAA may be reduced in a unit where all patients with ruptured AAA are considered first for EVAR. METHODS: During a 24-month period beginning in July 2002, 51 patients admitted with ruptured AAA were considered for EVAR as the treatment of choice and comprised the study group. EVAR was performed in 17 patients. Open repair was performed in 34 patients: 13 patients had hemodynamic instability and 16 patients had an unsuitable aortic neck anatomy. The study group was compared with a historical control group of 41 patients with ruptured AAA who were treated by open repair from July 2000 to June 2002. RESULTS: Mortality rate was 39% in the study group compared with 59% in the control group (P = .065). The duration of stay in the intensive care unit was significantly lower in the study group than in the control group (P = .01), although the total in-hospital stay was similar (17 days vs 14 days, P = .83). Within the study group, EVAR patients had a mortality rate of 24% compared with 47% in the open group (P = .14). CONCLUSION: Although the number of patients was small, offering EVAR to as many patients as possible with ruptured AAA has resulted in a 20% reduction in mortality, albeit statistically insignificant. However, it is in the unstable patients that EVAR will need to improve survival before it may be hailed to supersede the conventional approach.