Change in aneurysm diameter after stent-graft repair of ruptured abdominal aortic aneurysms

Purpose: To compare the changes in aneurysm size following endovascular aneurysm repair (EVAR) for ruptured versus elective abdominal aortic aneurysms (AAA). Methods: Aneurysm sac diameter was measured from computed tomographic (CT) scans in 14 hemodynamically stable patients (14 men; mean age 74+/-7 years, range 60 to 83) prior to emergent stent-graft repair for ruptured AAA. The aneurysm diameter change was followed postprocedurally with serial CT and the outcomes compared to 74 AAA patients (58 men; mean age 74 7 years, range 56 to 87) having elective EVAR in the same time period. The mean rate of sac decrease (mm/month) was calculated for each group. Results:There were 3 postoperative deaths in the ruptured AAA cohort, leaving 11 patients available for follow-up analysis (mean 16 months, range 2-49). Eight (73%) patients with ruptured AAA demonstrated significantly decreased (>5 mm) aneurysm diameters compared with 32 (43%) elective cases (p=0.07) followed a mean 20 months (range 3-51). The mean rate of sac diameter decrease was 1.50+/-1.03 mm/month in the rupture group versus 0.73+/-0.86 mm/month in the elective group (p=0.04). Conclusions: This study suggests that ruptured AAAs treated with stent-graft experience sac regression at a higher rate compared with electively treated AAA. The reasons for these findings remain unclear.