Endovascular treatment of ruptured and symptomatic abdominal aortic aneurysms.

摘要

OBJECTIVE: To report the experience of endovascular repair (ER) in patients with ruptured and symptomatic abdominal aortic aneurysms (rAAA and sAAA), comparing results with a cohort of controls who underwent open repair (OR) of sAAA or rAAA. DESIGN: A historically controlled cohort study. MATERIALS: Retrospective data from 21 patients who underwent ER and prospective data from 23 patients who underwent OR. METHODS: Results were compared using the Mann-Whitney U-test. RESULTS: Eleven ER patients had sAAAs and 10 had rAAAs. Nine OR patients had rAAAs and 13 had sAAAs. Thirty-day mortality was 11% in patients with rAAA in the ER group, and 54% in the OR group (p=0.03). There were no post-operative deaths in the patients who had an sAAA in the ER group, and one death in the patients who had sAAA in the OR group. Results as expressed as mean ER value versus mean OR value and p-value. ER was associated with significant reductions in the length of operation (2.6 versus 3.1h, p=0.03), blood transfusion requirements (0.86 versus 10.7 units p<0.01), time in critical care (1.5 versus 6.1 days, p=0.02), and total hospital stay (8.5 versus 17.5 days, p=0.01) compared with OR. There was no difference in time from admission to arrival in theatre between the two groups (3.4 versus 5.0h, p=0.35). CONCLUSIONS: In patients with rAAA and sAAA that are suitable for stenting, ER has reduced mortality compared with open repair. Assessment for ER does not cause a pre-operative delay, operating time is reduced, blood transfusion requirements are reduced and there is a faster recovery.