News | November 23, 2009

Endovascular Repair of Ruptured Aneurysms Superior to Surgery

Frank Veith, M.D.

November 21, 2009 – Endovascular repair of a ruptured abdominal aortic aneurysm (EVAR) is superior to open repair, according to a study data released Nov. 18-22 at the VEITH Symposium in New York. The study found EVAR is best in patients with favorable anatomy and in centers that have access to vascular surgeons.

“Case and single center reports have documented the feasibility and suggested the effectiveness of EVAR of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial,” said Frank Veith, M.D., professor of surgery at New York University Medical Center and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.

Dr. Veith and investigators examined a collected experience with use of EVAR for RAAA treatment from 49 centers. 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 1,037 patients treated by EVAR and 763 patients treated by open repair (OR).

Overall 30-day mortality after EVAR in was 21.2 percent. Centers performing
EVAR for RAAAs whenever possible did so in 28-79 percent of their patients, had a 30-day mortality of 19.7 percent for 680 EVAR patients and 36.3 percent for 763 OR patients. Supraceliac aortic balloon control was obtained in about 19.1 percent of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in about 12.2 percent of these EVAR patients.

“There is no doubt that these results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is superior to 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,” Dr. Veith said.

The study was published in the November 2009 issue of the Annals of Surgery.

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