Characteristics And Outcomes Of Ruptured Abdominal Aortic Aneurysm Repair Among Younger Patients

Although increasing age is a known independent predictor of death after the treatment of ruptured abdominal aortic aneurysms (rAAA), the characteristics and outcomes of rAAA repair among younger patients, who do not qualify for screening based on current guidelines, are poorly understood. A retrospective review of all rAAA patients presenting to a single academic center between January 2002 and December 2018 was performed. Patients were separated into two groups based on age, and those who did not undergo a repair were excluded. Baseline demographics, clinical status, and outcomes were recorded. The primary outcome was 30-day mortality, with secondary outcomes including postoperative complications and rate of home discharge. A total of 386 patients met inclusion criteria during the 17-year study period. Younger patients (age ≤ 65, n = 68) had significantly lower mean Harborview Risk Scores (HRS) on presentation compared with older (age ≥ 66, n = 318) patients (0.6 vs 1.4, P < .001). Younger patients also had significantly lower rates of coronary artery disease (26.5% vs 39.9%, P = .04) and diabetes (4.4% vs 14.2%, P = .03), though were more likely to be smokers (52.9% vs 28.6%, P < .001). There was no difference in mean aneurysm diameter (80 mm vs 83 mm, P = .30) (Fig), rates of endovascular aneurysm repair (EVAR) candidacy (64.7% vs 66.5%, P = .87), or rates of EVAR (38.2% vs 39%, P = 1). After rAAA repair, younger patients had significantly lower 30-day mortality (23.5% vs 48.1%, P < .001) and significantly higher rates of home discharge (50% vs 30.2%, P = .003). No differences were seen in postoperative complications (P > .05). Among the 66- to 76-year-old subgroup (n = 156), which would not qualify for an additional HRS point for age >76, a higher 30-day mortality was seen compared with the younger group (38.5%, P = .03) despite no differences in rates of EVAR candidacy (65.1%, P = 1), rates of EVAR (42.3%, P = .66), mean AAA diameter (85 mm, P = .14), or rates of postoperative complications. Only 17% (12) of the patients younger than 65 had a known AAA diagnosis before rupture. Younger patients with rAAA have lower rates of mortality and higher rates of home discharge despite no differences in AAA size at rupture, EVAR candidacy, rate of EVAR, or rate of organ dysfunction after repair. Importantly, most of these patients had no previous diagnosis of AAA, and do not qualify for screening. Further work is needed to determine whether the screening guidelines should be adjusted to capture these patients before rupture.TableDemographics, clinical features, and outcomesAge ≤ 65Percentage or rangeAge ≥ 66Percentage or rangeP valuePatients68318Mean age (range)60.949-6576.866-93