Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysms in a Chinese Population

Background: The aim of this study was to compare the perioperative outcomes and midterm survival rate between open surgical repair (OSR) and endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) in a Chinese population. Methods: A retrospective review was performed of the demographic characteristics and perioperative outcomes from 59 RAAA patients (mean 66.6 +/- 13.3 years of age; 49 men) undergoing OSR or EVAR at our center between January 2003 and November 2014. The perioperative mortality and midterm survival were assessed and compared between the OSR and EVAR groups. Results: Twenty-three patients underwent OSR, and 36 patients underwent EVAR. The overall 30-day mortality was 36.5% (47.8% OSR vs. 27.8% EVAR, P = 0.14). Total surgical time, estimated blood loss, and blood transfusion in the OSR group were significantly greater than those in the EVAR group (P < 0.001). Reintervention within 30 days and during the follow-up was more frequent in the EVAR group (36.1%) than in the OSR group (8.7%, P = 0.026). The mean follow-up was 38.2 +/- 29.3 months (range 6-100). A Kaplan-Meier survival curve analysis showed no significant difference between the 2 groups (P = 0.079). The overall survival rate at 1 year was 52.5% (31/59). Univariate and multivariate logistic regression analyses demonstrated that free intraperitoneal rupture (odds ratio [OR] 0.143, 95% confidence interval [CI] 0.030-0.694, P = 0.016) and cardiovascular disease (OR 0.072, 95% CI 0.006-0.898, P = 0.041) were independent risk factors for the 30-day mortality. Only intraperitoneal rupture was associated with the higher midterm mortality (OR 4.852, 95% CI 1.046-22.499, P = 0.044). Conclusions: In an experienced vascular center in China, although the 30-day mortality and midterm survival of RAAAs were not significantly different between the EVAR and OSR groups, EVAR has superior perioperative advantages. Consequently, EVAR is recommended as the first-line treatment for anatomically suitable RAAA.