Endovascular Repair Better for Ruptured Abdominal Aortic Aneurysms

A new study has found that endovascular treatment of ruptured abdominal aortic aneurysms (RAAAs) is faster and associated with less morbidity when compared with open surgical repair.

Researchers at Northwestern University (Chicago, IL, USA) compared the outcomes for 15 RAAAs treated with endovascular repair and 22 other patients who underwent standard open surgical repair that comprised a control group for comparison. The procedures were performed between 2000 and 2005. Endovascular repair was made with stent graft exclusion using currently available systems. Vascular access was achieved with femoral artery cutdown in the first four endovascular repair patients; in the remaining cases, an entirely percutaneous approach was used.

The study results showed that endovascular repair achieved a technical success rate of 100%. On average, endovascular repair took 107 minutes to perform, required 6.6 units of blood, and had hospital stay of 3 days, all of which were significantly reduced compared with open surgical repair. Thirty-day mortality was also significantly lower with endovascular repair: 6.7% vs. 13.6% with surgery. In addition, no late complications, such as pseudoaneurysm or infection, were seen with endovascular repair during an average follow-up period of 12 months. The study was published in the November 2007 issue of Archives of Surgery.

"Achieving good results with this approach requires not only good technique and extensive prior experience with elective endovascular AAA repair, but a strong commitment by the hospital to support such an endeavor” said lead author Mark K. Eskandari, M.D., of the division of vascular surgery. "It requires buy-in by several specialties, an on-call team, an operating room angiosuite, and immediate availability of the endovascular devices.”


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