Comparative Outcomes for Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms Using Anatomic Criteria for Treatment Approach

Care pathways and endovascular therapy have improved early survival in patients with ruptured abdominal aortic aneurysms (RAAAs), with systematic reviews and randomized controlled studies suggesting similar outcomes for both open (O-RAAA) and endovascular (E-RAAA) repairs. These studies evaluated patients who were suitable for both treatment options. We compare outcomes of both treatments in patients with RAAA when treatment selection is based on anatomy. Patients with RAAA (between 2010 and 2017) were identified from a prospective database maintained by two academic centers. If anatomy was suitable, E-RAAA repair was used; if not, patients received O-RAAA repair. Bivariate analysis was done using t-tests, χ2 tests, and Fisher exact tests comparing characteristics of O-RAAA and E-RAAA patients, method of treatment, need for transfusion, and 30-day mortality. Tertiles of Glasgow Aneurysm Score (GAS) were used to compare physiologic status at arrival as well as differences between two treatment options. Odds ratio (OR) with 95% confidence intervals (CIs) and P values were reported from multivariable generalized estimating equation controlling for the autocorrelations among patients coming from two centers with logit link function to estimate the odds of 30-day mortality. The study included 199 patients. Table I provides results of the bivariate analysis with characteristics of the patients for the two treatment options. Patients receiving E-RAAA repair had reduced length of stay and need for blood products, with no difference in the 30-day mortality (P = .2538). As in Table II, model 1 (GAS not used for adjustment) study variables for 30-day mortality showed no difference between O-RAAA and E-RAAA repairs (OR, 0.44; 95% CI, 0.18-1.1; P = .0799). Model 2 (Table II) indicates there is significant difference in 30-day mortality (OR, 0.31; 95% CI, 0.17-0.55; P < .001) with GAS considered. Female patients and patients with higher body mass index were more likely to die within 30 days after surgery (P < .05). The Fig shows differences in 30-day mortality favoring E-RAAA repair at low to medium GAS scores but no difference at high scores. This real-world experience suggests reduced 30-day mortality for patients undergoing E-RAAA repair when anatomy is feasible. Patients with poor physiologic score at arrival have no such difference irrespective of the treatment approach chosen.Table IResults from bivariate analysisRAAA repairP valueOpen (n = 109)Endovascular (n = 90)Age, years72 (8.76)71 (9.69).5634Sex (M:F)75:2580:20.3435Body mass index29.38 (6.36)30.03 (6.98).603Length of stay, days11.84 (9.83)6.76 (7.49)