A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair

BACKGROUND: Operative repair of ruptured abdominal aortic aneurysm (RAAA) is associated with a high mortality rate but reported figures vary widely. The aim of this study was to estimate the operative mortality of RAAA repair and determine how it has changed over time. METHODS: A meta-analysis of all English language literature quoting figures for operative mortality of RAAA repair. RESULTS: The pooled estimate for the overall operative mortality rate of RAAA repair from 1955 to 1998 was 48 (95 per cent confidence interval 46 to 50) per cent. Meta-regression analysis of operative mortality over time demonstrated a constant reduction of approximately 3.5 per cent per decade (1954-1997) with an operative mortality rate estimate for the year 2000 of 41 per cent. Seventy-seven studies reported intraoperative mortality but, while this appears to have remained constant over time, there was evidence of the presence of publication bias in the subgroup of papers reporting this outcome. There was no evidence of publication bias for the overall operative mortality outcome. CONCLUSION: Contrary to the conclusion of recent studies, this paper demonstrates a gradual reduction with time in the operative mortality rate of RAAA repair.     

Community mortality after ruptured abdominal aortic aneurysm is unrelated to the distance from the surgical centre

BACKGROUND: Ruptured abdominal aortic aneurysm (RAAA) carries a high community mortality. Raigmore Hospital, Inverness serves Highland Region, an area the size of Wales with a population of 204,000. The aim of this retrospective review was to determine the community mortality and hospital mortality rates from RAAA in Highland Region and to assess whether distance travelled had any significant impact on survival. METHODS: Data were retrieved from hospital records, the Registrar General for Scotland and the Information and Statistics Division of the National Health Service in Scotland about patients diagnosed with RAAA between 1992 and 1999. RESULTS: Of 198 patients with RAAA, 131 (66 per cent) were transferred to Raigmore Hospital while the other 67 (34 per cent) died in a community hospital or at home. Of those reaching Raigmore 109 (83 per cent) had surgery, of whom 65 (60 per cent) survived. The overall community mortality rate was 67 per cent while the hospital mortality rate was 50 per cent. The hospital and community mortality rates for patients living within 50 miles of Raigmore Hospital were 60 and 67 per cent respectively, compared with 26 and 68 per cent for those living more than 50 miles away. CONCLUSION: Distance from Raigmore Hospital had no significant impact on community mortality from RAAA.     

Stent-graft repair for acute traumatic thoracic aortic rupture

Traumatic rupture of the thoracic aorta is potentially life-threatening and leads to death in 75 to 90 per cent of cases at the time of injury. In high-risk patients, as traumatic injuries of the aorta combine with multiple associated injuries, endoluminal repair is now reported as a promising therapeutic strategy with encouraging results. This study determined the outcome of patients with traumatic thoracic aortic injury treated endovascularly during the past 7 years at our institution. Thirteen patients, 11 males and 2 females (mean age, 39 years; range, 19-82), with traumatic rupture of the otherwise unremarkable descending aorta (10 acute, 3 chronic), out of a series of 64 endovascular thoracic stent-graft procedures, were treated by implantation of Talent (n = 8), Vanguard (n = 5), and Excluder (n = 2) self-expanding devices between January 1996 and August 2003. The immediate technical success rate was 92 per cent (12/13). One patient showed a proximal endoleak type I, which was treated successfully by an additional stent-graft procedure. Secondary success rate was 100 per cent. The mortality rate was 0 per cent. Two additional stent-graft procedures were performed due to type I endoleaks after 18 and 28 months. There was no other intervention-related morbidity or mortality during the mean follow-up time of 26.4 months' (range, 6-86). Endovascular stent-graft repair of traumatic thoracic aortic injuries is a safe, effective, and low-morbidity alternative to open thoracic surgery and has promising midterm results.     

Identifying Patients With AAA With the Highest Risk Following Endovascular Repair

Introduction: It has been demonstrated that endovascular repair of arterial disease results in reduced perioperative morbidity and mortality compared to open surgical repair. The rates of complications and need for reinterventions, however, have been found to be higher than that in open repair. The purpose of this study was to identify the predictors of endograft complications and mortality in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair; specifically, our aim was to identify a subset of patients with AAA whose risk of periprocedure mortality was so high that they should not be offered endovascular repair. Methods: We undertook a prospective review of patients with AAA receiving endovascular therapy at a single institution. Collected variables included age, gender, date of procedure, indication for procedure, size of aneurysm (where applicable), type of endograft used, presence of rupture, American Society of Anesthesiologists (ASA) class, major medical comorbidities, type of anesthesia (general, epidural, or local), length of intensive care unit (ICU) stay, and length of hospital stay. These factors were correlated with the study outcomes (overall mortality, graft complications, morbidity, and reintervention) using univariate and multivariate logistic regression. Results: A total of 199 patients underwent endovascular AAA repair during the study period. The ICU stay, again, was significantly correlated with the primary outcomes (death and graft complications). In addition, length of hospital stay greater than 3 days, also emerged as a statistically significant predictor of graft complications in this subgroup (P = .024). Survival analysis for patients with AAA revealed that age over 85 years and ICU stay were predictive of decreased survival. Statistical analysis for other subgroups of patients (inflammatory AAA or dissection) was not performed due to the small numbers in these subgroups. Conclusions: Patients with AAA greater than 85 years of age are at a greater risk of mortality following endovascular repair. In addition, patients who are expected to require postprocedure ICU admission are also at an increased risk of mortality following endovascular repair.     

Ureteral calculi: review of 17 years of experience at a community hospital.

In the last 17 years 3,150 patients have been treated by one or both of us for ureteral calculous disease. Our operative mortality is zero and our operative morbidity is 0.68 per cent, with an over-all morbidity of 0.8 per cent. We believe that stone extractions decrease the length of hospital stay and the time lost from industry, home or school. Thus, it is a worthwhile, effective and safe procedure. We agree with other investigators who believe that ureteral catheters and antibiotics are not necessary for routine stone extraction. We will await further word on the etiology of this endemic disease.     

Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms

INTRODUCTION: The successful application of endovascular techniques for the elective repair of abdominal aortic aneurysms (AAAs) has stimulated a strong interest in their possible use in dealing with a long-standing surgical challenge: the ruptured abdominal aortic aneurysm (RAAA). The use of a conventional open procedure to repair ruptured aneurysms is associated with a high operative mortality of 45% to 50%. In this study, we evaluated the current frequency of endovascular repair of RAAAs in four large states and the impact of this technique on patient outcome. METHODS: We examined discharge data sets from 2000 through 2003 from the four states of California, Florida, New Jersey, and New York, whose combined population represents almost a third of the United States population. Proportions and trends were analyzed by chi2 analysis and continuous variables by the Student's t test. RESULTS: We found that since the year 2000, endovascular repair has begun to emerge as a viable treatment option for RAAAs, accounting for the repair of 6.2% of cases in 2003. During the same period, the use of open procedures for RAAAs declined. The overall mortality rate for the 4-year period was significantly lower for endovascular vs open repair (39.3% vs. 47.7%, P = .005). Moreover, compared with open repair, endovascular repair resulted in a significantly lower rate of pulmonary, renal, and bleeding complications. Survival after endovascular repair correlated with hospital experience, as assessed by the overall volume of elective and nonelective endovascular procedures. For endovascular repairs, mortality ranged from 45.9% for small volume hospitals to 26% for large volume hospitals (P = .0011). Volume was also a determinant of mortality for open repairs, albeit to a much lesser extent (51.5% for small volume hospitals, 44.3% for large volume hospitals; P < .0001). CONCLUSION: We observed a benefit to using endovascular procedures for RAAAs in institutions with significant endovascular experience; however, the analysis of administrative data cannot rule out selection bias as an explanation of better outcomes. These data strongly endorse the need for prospective studies to clarify to what extent the improved survival in RAAA patients is to be attributed to the endovascular approach rather than the selection of low-risk patients.     

The role of vascular registries in improving the management of abdominal aortic aneurysm.

Treatment of abdominal aortic aneurysm (AAA) is one of the vascular surgical index procedures and an important part of the total workload. Whichever way treated, it typically has high mortality and morbidity. Furthermore, endovascular repair is still a relatively new treatment method and under evolution. Therefore continuous quality control with subsequent outcome analysis, benchmarking, intervention and reassessment are mandatory to achieve high level aneurysm care. Vascular registries are tools for this audit. The aim of this review is to focus on the problems and solutions related to attempts to improve the management of abdominal aortic aneurysm with emphasis on the experience gathered in Finland. This includes great variations in dynamics over time in Southern Finland. To control the influence of patient selection and case-mix, total hospital mortality is emphasized as the most appropriate outcome measure of the level of treatment of ruptured abdominal aortic aneurysm (RAAA). Total aneurysm mortality (including total hospital mortality of RAAA and other AAA surgery) is introduced as an outcome measure of vascular service.     

Abdominal aortic aneurysm surgery in a district general hospital: a 15-years experience

The incidence of patients presenting with both ruptured abdominal aortic aneurysm (RAAA) and elective abdominal aortic aneurysm (EAAA) increases with age. The aim of our study was to find out the incidence of RAAA, age and sex groups of patients at risk, and 30-day all-cause perioperative mortality associated with RAAA as well as EAAA repair in a busy district general hospital over a 15-year time period. All patients operated for AAA during 1989-2003, both elective and ruptured, were included in the study. Patients who died in the community from RAAA were also included. The data were collected from the hospital information system, theater logbooks, intensive therapy unit records, postmortem register, and patients' medical notes. We divided the data for RAAA into two groups of 7.5 years each to see if there was any improvement over time in 30-day postoperative mortality. There were 816 cases of AAA, which included 468 RAAAs (57%) and 348 EAAAs (43%). Out of 468 RAAAs, 243 patients had emergency repair, of whom 213 were males. There were 201 patients who had RAAA postmortem (43%). Median age (range) was 73 (54-94) years in males and 77 (52-99) years in females, with a male-to-female ratio of 7:1. The peak incidence of RAAA was over 60 years of age in males and 70 years in females. Incidence of RAAA was 7.3/100,000/year in males and 5/100,000/year in females. For RAAA, 30-day perioperative mortality was 43% (105/243) while overall mortality was 70% (330/468), which includes deaths in the community. There was no improvement in 30-day mortality over time after comparing data for the first 7.5 years (50/115, 43.5%) with those for the second set of 7.5 years (55/128, 43%). There were 348 patients who had EAAA repair over the same period, comprising 282 males, with a male:female ratio of 4.3:1. The 30-day mortality in the elective group was 7.75%. Incidence and mortality of RAAA remain high. A high proportion of patients with AAA remain undiagnosed and die in the community. More lives may be saved if a screening program is started for AAA.     

The effect of patient transfer on outcomes after rupture of an abdominal aortic aneurysm

OBJECTIVE: Centralization of vascular surgery services has resulted in patients being transferred longer distances for treatment of life-threatening conditions. The purpose of this study was to determine whether patient transfer adversely affects the survival of people with a ruptured abdominal aortic aneurysm (RAAA). METHODS: We performed a retrospective review of all patients undergoing attempted repair of an RAAA at our centre, over a recent 3.5-year period (August 2000-December 2003). Patients were divided into those presenting directly to our centre and those transferred from another hospital. The main outcome variable was in-hospital or 30-day mortality, with secondary variables including time to surgical treatment, mortality in the first 24 hours and length of hospitalization. RESULTS: Eighty-one patients (73% men) underwent attempted open repair of an RAAA at our centre during this period. Twenty-four patients (29.6%) presented directly to our hospital, while 57 (70.4%) were transferred from another institution. The overall mortality rate was 53%. Although transferred patients took twice as long as direct patients to get to the operating room (6.3 v. 3.2 h, p=0.03), there was no difference in mortality between the 2 groups (50% v. 54%, p=ns). However, deaths of transferred patients were more likely to occur in the first 24 postoperative hours, compared with direct patients (40% v. 33%, p<0.05). Neither mean intensive care unit stay (5.8 and 8.1 d) nor total hospitalization (20.9 and 18.8 d) differed between the 2 groups. CONCLUSIONS: Although the transfer of patients with RAAA results in a treatment delay, it does not adversely affect the already high mortality rates associated with this condition. These results may be attributed to a preselection of patients who are able to tolerate such a delay.     

Endovascular treatment of traumatic rupture of the thoracic aorta

BACKGROUND: Traumatic rupture of the thoracic aorta is a life-threatening event. Open surgical repair is the 'gold standard', but is associated with high mortality and morbidity rates. Endovascular repair is emerging as a potentially safer alternative. METHODS: A systematic review was performed of all published literature on this subject, including the authors' own experience. Using Sumsearch, PubMed and cross-references, all published reports up to January 2006 were identified, and analysed for injuries, perioperative morbidity, mortality, operating time, hospital stay and follow-up. RESULTS: A total of 284 patients were identified. Reported mortality rates range from 0 to 6 per cent. The procedure-related mortality rate is about 1.5 per cent. Some 6.7 per cent of all procedures were complicated by endoleak and the overall procedure-related morbidity rate was 14.4 per cent. These results are promising compared with those of open repair, but individual experience is limited and there may be some publication bias. CONCLUSION: Endovascular repair of traumatic rupture of the thoracic aorta seems to reduce morbidity and mortality in patients with multiple trauma. Ideally, both devices and experienced personnel should be available in trauma centres.     

Ruptured abdominal aortic aneurysm: a 25-year experience and analysis of recent cases

An 8-year experience with treatment of 58 patients with ruptured abdominal aortic aneurysm (RAAA) is reviewed with hospital mortality of 25.9 per cent. Added to a previously reported experience, 115 patients have been treated over 25 years with 33 per cent mortality. Preoperative hypotension, free rupture, venous injury, and massive transfusion were found to be associated with mortality. Interhospital transfer, preexisting coronary or pulmonary disease, known aneurysm, anemia, delay in surgery, and operative time were not found to predict outcome. Some patients are normotensive at presentation, providing an excellent chance for survival when expeditious diagnosis and treatment are carried out. Optimal operative management, complications, and causes of death are discussed. The role of computed tomography (CT) in diagnosis is considered. Elective resection of known aneurysms is the most important factor in reducing deaths from RAAA. The role of regionalization of care is unclear, since some patients cannot be safely transported. However, some evidence for optimal results in specialized centers is presented.     

Clamp before you cut: Proximal control of ruptured abdominal aortic aneurysms using endovascular balloon occlusion--Case reports

While the mortality rate for elective abdominal aortic aneurysm (AAA) repair has declined over the last several decades, the rate for ruptured abdominal aortic aneurysm (RAAA) has unfortunately remained disturbingly high. Undiagnosed aneurysms may present with little warning until abdominal pain, syncope, and hypotension signify rupture. Fifty percent of patients with ruptured aneurysms die before reaching a medical facility, and their survival is highly dependent on hemodynamic stability at presentation. The degree of rupture containment and comorbid status of the patient determine hemodynamic stability. Endovascular stent grafting has significantly improved perioperative morbidity and mortality rates for elective AAA repair, and some of the same endovascular techniques can be used to obtain proximal control in patients presenting with RAAA. We describe 3 consecutive cases of RAAA where proximal control was obtained using a percutaneously placed, transfemoral aortic occlusion balloon before induction of anesthesia.     

Impact of delay on survival in patients with ruptured abdominal aortic aneurysm

Rupture of the abdominal aortic aneurysm (RAAA) is a common surgical emergency. Surgical treatment of this condition carries a high morbidity and mortality rate. For successful outcome, an early diagnosis and prompt treatment are essential. However, recently, some centers have reported better results in patients whose surgery had been delayed because of interhospital transfer. Delay in treatment sometimes occurs as patients are transferred from one institution to another where specialized vascular care is available. This retrospective study sought to determine the effect of delay in treatment on the mortality of patients with RAAA repair.The time from arrival at the emergency room to surgery and operative time were obtained from the case notes of 45 consecutive patients with RAAA. Patients' physiology scores on admission were calculated using V-POSSUM for the RAAA model.Thirty-five patients were diagnosed with RAAA in the emergency room and were transferred to surgery. These patients were divided into two groups: patients who had surgery within 1 hour (n = 23) and those in whom surgery was delayed for up to 4 hours (n = 12).There was no significant difference in physiology score between the two groups (p = .12). The time to surgery and operative time with death as the outcome were plotted on a logistic regression model that showed that the delay in surgical treatment increases the mortality rate following RAAA repair (p = .041). Furthermore, a long operative time was associated with a higher surgical mortality rate (p = .029).Delay to surgery and a long operation increase the mortality rate following RAAA repair. However, delay to surgery alone did not influence the mortality rate.     

Stenting for infantile adult aortic coarctation with successful conception of zygomatic twins at 4 years’ post-intervention

INTRODUCTIONAortic coarctation is a congenital defect which rarely presents in adulthood but results in significant morbidity and mortality. Endovascular techniques present novel therapeutic options for managing this anomaly with comparable results to traditional open surgical repair.PRESENTATION OF CASEWe convey a case of postductal aortic coarctation in a symptomatic 31-year-old woman, undetected, despite 27 years history of congenital bicuspid valve with aortic incompetence. We staged a successful endovascular repair following presentation with hypertension, abdominal pain, and worsening lower limb claudication. This lady recovered well, eventually giving birth to twins after a successful caesarean section delivery. The anatomical, clinical and technical features of the case are appraised.DISCUSSIONAortic coarctation is classified anatomically as preductal (infantile) or postductal (adult) and the morphological spectrum of abnormality ranges from a discrete stenosis distal to the left subclavian to a hypoplastic transverse arch and aortic isthmus presenting in infancy. Its incidence is 0.2–0.6 per 100 live births. Traditional open surgical repair of aortic coarctation is associated with high morbidity and mortality. Advances in endovascular techniques with their associated shorter hospital time and lower costs, reduced short term morbidity and mortality mean that they are likely to become mainstays of treatment.CONCLUSIONThe presentation of aortic coarctation for the first time in an adult is extremely unusual. Error and delayed diagnosis can never be fully exempted in the practice of medicine even with the most advanced diagnostic tools. Follow-up is mandatory by trans-oesophageal echo in all endovascular patients.     

Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm

BACKGROUND: The aim was to assess to what extent the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and Hardman scoring systems were predictive of outcome after surgery for ruptured abdominal aortic aneurysm (RAAA). METHODS: From January 1990 to December 2001, 232 patients presented with RAAA. Forty-one were treated conservatively and all died; the remainder had emergency surgery. The case notes of all but three of these patients were reviewed retrospectively. POSSUM and Hardman scores were calculated and related to mortality. RESULTS: The mortality rate after emergency repair was 54 per cent (104 of 191). The physiology-only POSSUM score specific for RAAA and the Hardman Index score were both significantly associated with increased mortality after operation (P < 0.001). Most non-operated patients were in the highest risk bands. CONCLUSION: Both POSSUM and Hardman scoring systems predicted outcome after emergency surgery for RAAA. The Hardman Index was simpler to calculate, but POSSUM identified a higher number of patients at risk. Risk scoring may help identify patients with RAAA for whom surgery is futile.     

Physiological comparison of open and endovascular aneurysm repair.

BACKGROUND: This prospective study compared morbidity and mortality rates following conventional and endovascular abdominal aortic aneurysm (AAA) repair using a physiological scoring system. METHODS: Between December 1994 and November 1997, 104 elective open aneurysm repairs and 49 endovascular aneurysm repairs were performed. These patient cohorts were compared using the Portsmouth predictor equation (P-POSSUM) scoring system. Data collected prospectively from patient notes were used to obtain physiological and operative severity scores which were analysed to compare expected and observed mortality and morbidity rates. RESULTS: There were three deaths (6 per cent) in the endovascular AAA repair group and 17 (16 per cent) in the conventional aneurysm repair group, whereas the P-POSSUM formulae predicted mortality rates of 8 and 19 per cent respectively. Although the mean physiological scores were similar for both groups (endovascular 20.8 versus conventional 20.1), the operative severity score was significantly greater in the conventional group (26.3 versus 19.7; P < 0.001). CONCLUSION: In this study open aortic aneurysm repair had a higher operative severity than endovascular repair, which was reflected in the increased mortality rate.     

Endovascular management of traumatic ruptures of the thoracic aorta: a retrospective multicenter analysis of 28 cases in The Netherlands

BACKGROUND: Minimally invasive endovascular treatment of a traumatic rupture of the thoracic aorta is a new strategy in the care of multitrauma patients. We report the experience in The Netherlands with endovascular management of patients with acute traumatic ruptures of the thoracic aorta. METHODS: We reviewed 28 patients with a traumatic thoracic aortic rupture treated with a thoracic aortic endograft between June 2000 and April 2004. All patients underwent treatment at one of the four participating level 1 trauma centers. Data collected included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Follow-up data consisted of computed tomographic angiography and plain chest radiographs at regular intervals. RESULTS: All patients (mean age, 40.9 years; SD, 18.5 years) experienced severe traumatic injury, and the mean injury severity score was 37.1 (SD, 7.8). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 58 minutes (interquartile range, 47-88 minutes). The overall hospital mortality was 14.3% (n = 4), and all deaths were unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during a median follow-up of 26.5 months (interquartile range, 10-34.6 months). Postoperative data showed no severe endovascular graft- or procedure-related morbidity, except for one patient with an asymptomatic collapse of the endovascular graft during regular follow-up. This was corrected by placing a second graft. CONCLUSIONS: This study shows that the results of immediate endovascular repair of a traumatic aortic rupture are at least equal to those of conventional open surgical repair. Especially in these multitrauma patients with traumatic ruptures of the thoracic aorta, endovascular therapy seems to be preferable to conventional open surgical repair.     

破裂腹主动脉瘤的外科治疗体会(附20例报道)

目的探讨破裂腹主动脉瘤的诊断和外科治疗方法。方法回顾性分析2000年1月至2010年12月期间新疆维吾尔自治区人民医院收治的20例破裂腹主动脉瘤患者的临床资料。结果男18例,女2例;年龄31～82岁,平均65.4岁。所有患者中突发性腹或腰背部疼痛20例,血压下降和(或)休克11例,发病前有明确腹主动脉瘤病史7例。所有患者均经彩超、CTA或手术探查确诊。19例患者采用传统开腹手术,1例行腔内支架人工血管置入术。20例患者中围手术期死亡4例,死亡率为20%,死亡原因为循环衰竭1例,多器官功能障碍综合征3例。存活的16例患者恢复顺利。结论手术治疗破裂腹主动脉瘤有效,早期诊断,急诊外科手术,是降低病死率的关键。     

Endovascular repair of ruptured abdominal aortic aneurysms: systematic literature review

Endovascular repair is increasingly used for ruptured abdominal aortic aneurysms (RAAAs). This study estimated the mortality rate for this approach. A review of 307 publications in English was performed. Thirty-four publications representing 1,200 patients with RAAA were deemed appropriate for analysis by weighted least squares regression. Of the 1,200 patients, 531 (44.3%) underwent endovascular aneurysm repair (EVAR). The average age was 74 years, and 13% were female. Aortouni-iliac grafts were used in 49.4% of patients, and 50.6% received bifurcated grafts. The technical success rate was 94.9%, with a mortality rate of 30.2%. The ratio of endovascular cases to the total number of cases strongly predicted the mortality rate (weighted coefficient -0.378, p< .0003). The mortality rate following EVAR of RAAA is 30%. A 3.8% reduction in mortality was found for each 10% increase in the percentage of ruptures repaired endovascularly at each center. These results are suggestive of a learning curve.     

The Amsterdam Acute Aneurysm Trial: Suitability and Application Rate for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

PURPOSE: To evaluate anatomical suitability and application rate for endovascular repair of patients with a ruptured abdominal aortic aneurysm (RAAA). METHODS: The Amsterdam Acute Aneurysm trial is a multicenter randomised trial comparing open with endovascular treatment in patients with a RAAA (International Standard Randomized Controlled Trial Number (ISRCTN) 66212637). Between April 2004 and January 2006, all consecutive patients with clinical suspicion of a RAAA at presentation were assessed prospectively. Anatomical suitability for endovascular repair was based on use of an aorto-uni-iliac endovascular graft and assessed in patients with a proven aortic rupture on CT angiography (CTA). RESULTS: In 128/256 patients, presenting with clinical suspicion of a ruptured aneurysm, RAAA was diagnosed. 105 patients were brought to a trial center and CTA confirmed RAAA in 83 patients. In 38 of 83 patients (45.8%) with positive CTA, the anatomy of the aorta and iliac arteries was considered suitable for endovascular repair. Exclusion from endovascular repair was due to unsuitable infrarenal neck or iliac anatomy (37 and 8 patients respectively). Overall, endovascular treatment was applicable in 38/128 patients (29.7%) with a RAAA in the Amsterdam region and in 38 out of 105 patients (35.5%) admitted to the trial centers. CONCLUSION: In this prospective cohort of all patients with a RAAA in the Amsterdam Acute Aneurysm Trial region, the suitability for endovascular repair in patients with a RAAA confirmed on CTA is 45.8%, but the application rate was lower.