Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. outcome of a prospective intent-to-treat by EVAR protocol

Objective: outcome of treatment of patients with ruptured or symptomatic non-ruptured aneurysm (rAAA and snrAAA), preferentially treated by emergency endovascular repair was assessed. The outcome was compared with a historical group of patients treated by open repair. Patients and methods: two groups of patients presenting with acute symptomatic AAA were compared. Group I (study group) consisted of 40 consecutive prospectively enrolled patients from May 2001 until June 2002, in whom emergency endovascular abdominal aortic aneurysm repair (e-EVAR) was the preferential management. Short or wide neck or profound hypovolemic shock were exclusion criteria for e-EVAR. Group II (control group) consisted of 28 patients, retrospectively analysed, all treated by conventional surgical repair between January 1999 and May 2001. In group 1, 26 patients had rAAA and in group 1122 patients. The other patients had snrAAA. Results: in group 1, 14 patients were treated by open repair. Unsuitable anatomy or profound hypovolemia was the cause of open repair in eight patients, while logistic reasons were the reasons for use of open repair in six patients (off-protocol use of open surgery). Thus, in this prospective series the feasibility of EVAR was 80% (32140). Patient characteristics, proportion rAAA or hemodynamically unstable patients were comparable in group I and II. Volume of blood loss and need for fluid transfusion were significantly less in group I compared to group II. The perioperative mortality in group I was significantly less than in group II (20% vs. 43%, respectively, p = 0.04). If patients with rAAA were considered the mortality was 31 % in group I and 50% in group II, which difference did not reach the level of statistical significance. Conclusion: e-EVAR was a feasible treatment in the majority of patients with rAAA and snrAAA. Blood loss and the requirements of fluid transfusion were significantly decreased. Most importantly in this institutional series significantly lower first-month mortality was observed in the group with preferential e-EVAR compared to a control group. A multicenter study assessing the outcome of preferential use of e-EVAR in patients with acute symptomatic AAA is required.