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Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

Veith, Frank J. MD*†; Lachat, Mario MD‡; Mayer, Dieter MD‡; Malina, Martin MD§; Holst, Jan MD§; Mehta, Manish MD¶; Verhoeven, Eric L.G. MD, PhD∥∥∥∥; Larzon, Thomas MD**; Gennai, Stefano MD††; Coppi, Gioacchino MD††; Lipsitz, Evan C. MD‡‡; Gargiulo, Nicholas J. MD‡‡; van der Vliet, J Adam MD§§; Blankensteijn, Jan MD, PhD§§; Buth, Jacob MD¶¶; Lee, W Anthony MD∥∥; Biasi, Giorgio MD***; Deleo, Gaetano MD***; Kasirajan, Karthikeshwar MD†††; Moore, Randy MD‡‡‡; Soong, Chee V. MD§§§; Cayne, Neal S. MD†; Farber, Mark A. MD¶¶¶; Raithel, Dieter MD, PhD∥∥∥; Greenberg, Roy K. MD*; van Sambeek, Marc R. H. M. MD, PhD¶¶; Brunkwall, Jan S. MD, PhD****; Rockman, Caron B. MD†; Hinchliffe, Robert J. MD††††; RAAA Investigators

doi: 10.1097/SLA.0b013e3181bdd7f5
Original Articles From the ESA Proceedings

Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial.

Objective: To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers.

Methods: Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible and included treatment details from a single center and information on 1037 patients treated by EVAR and 763 patients treated by open repair (OR).

Results: Overall 30-day mortality after EVAR in 1037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean 49.1%) of their patients, had a 30-day mortality of 19.7% (range: 0%–32%) for 680 EVAR patients and 36.3% (range: 8%–53%) for 763 OR patients (P < 0.0001). Supraceliac aortic balloon control was obtained in 19.1% ± 12.0% (±SD) of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% ± 8.3% (±SD) of these EVAR patients.

Conclusion: These results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is better than OR for treating RAAA patients provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.

This collected and single center experience with endovascular repair of ruptured abdominal aortic aneurysms showed a 30-day mortality, which was significantly lower than that for open repair. Based on these data, endovascular repair is a superior treatment for ruptured abdominal aortic aneurysms in patients with favorable anatomy in appropriate circumstances.

From the *Cleveland Clinic, Cleveland, OH; †New York University Medical Center, New York, NY; ‡Zurich University Hospital, Zurich, Switzerland; §Malmo University Hospital, Malmo, Sweden; ¶Albany Medical Center, Albany, NY; ∥University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; **Örebro University Hospital, Örebro, Sweden; ††Modena University Hospital, Modena, Italy; ‡‡Montefiore Medical Center, Bronx, New York, NY; §§University Medical Center Nijmegen, Nijmegen, The Netherlands; ¶¶Catharina Hospital, Eindhoven, The Netherlands; ∥∥University of Florida, Gainesville, FL; ***University of Milan, Milan, Italy; †††Emory University, Atlanta, GA; ‡‡‡Peter Lougheed Center, Calgary, Canada; §§§Belfast City Hospital, Belfast, United Kingdom; ¶¶¶University of North Carolina, Chapel Hill, NC; ∥∥∥University of Nuremberg, Nuremberg, Germany; ****University of Cologne, Cologne, Germany; and ††††University of Nottingham, Nottingham, United Kingdom.

The RAAA investigators include the following: Mohan Adiseshiah, Yves Alimi, Foppe Bekkema, Peter Bell, Jean-Pierre Becquemin, Cristian Benatti, Bruce Braithwaite, Walter Camesasca, Piergiorgio Cao, Robert Casali, Lucien Castellani, Johanna Chester, Frank Criado, Philippe Cuypers, Michael Dake, R. Clement Darling, Ken Eliasson, Mark Fillinger, Alberto Froio, Peter Gloviczki, Steven Goode, Goren Gruber, Brian Hopkinson, Kim Hodgson, Krassi Ivancev, Martin Kapma, Fabian Koskas, Christos Liapis, John Long, Willie Loan, Shane MacSweeney, Michel Makaroun, Jon Matsumura, Lajos Matyas, James May, Wesley Moore, Reinhard Pamler, Juan Parodi, Philip Paty, Ludgar Sunder-Plassmann, Thomas Pfammatter, Noud Peppelenbosch, Maria Piglionica, John Ross, Tim Resch, Sean Roddy, Brian Rubin, Giuseppe Saitta, Clifford Sales, Luis Sanchez, Roberto Silingardi, Bjorn Sonesson, John Taggert, Yaron Sternbach, Asko Toivola, Jos van den Berg, Lukas van Dijk, Frank Vermassen, Vittorio Villa, Rodney White, Burkhard Zipfel.

Reprints: Frank J. Veith, MD, 530 First Avenue, New York, NY 10016. E-mail: fjvmd@msn.com.

© 2009 Lippincott Williams & Wilkins, Inc.