Background:

the ruptured abdominal aortic aneurysm (rAAA) is associated with high morbimortality. The purpose of this study was to compare results of open surgical repair (OSR) and EVAR in our institution in the management of rAAA.

Material and methods:

retrospective observational cohort study was conducted on rAAA patients with infrarenal neck between January 2006 and December 2017. Sample was divided according to intervention: OSR vs. EVAR. Comorbidities, anatomical features, intervention and results were analyzed by repair method.

Results:

fifty-four patients were included, 26 (48,1 %) using OSR and 28 (51,9 %) using EVAR. Age (70,7 ± 7,8 years vs. 72,5 ± 9,5; p = 0,45) and comorbidities showed no statistical significance, except for dyslipidemia (26,9 % vs. 67,9 %; p = 0,003). Aneurysms were larger in OSR group (88,1 ± 17,9 mm vs. 72,4 ± 16 mm; p = 0,02), with a higher rate of associated iliac aneurysm (34,6 % vs. 17,8 %, p = 0,07). 65,4 % of patients in OSR group showed preoperative hemodynamic instability, compared to 60,7 % in EVAR group (p = 0,72). 50 % of EVAR procedures were performed under local anesthesia. Median intraoperative transfusion requirements for OSR group and EVAR group were, respectively, 11 ± 6 and 4 ± 3 red blood cell concentrates (p = 0.001). Hospital mortality was higher in OSR group (46.2 % vs. 28.6 %) (p = 0.18). There were four intraoperative deaths in this group. 54.5 % of OSR patients and 64.3 % of EVAR presented major complications. The most common ones were longtime intubation and acute renal failure requiring renal replacement therapy. Reintervention rate was 18.2 % in CA group and 25 % in EVAR group (p = 0.56), all reinterventions in EVAR group performed in rAAAs repaired by an aortouniiliac device. Two-year survival rate was 51.7 % in CA group and 65.2 % in EVAR group (p = 0.28).

Conclusions:

the treatment of rAAA still associates with high morbimortality rates. However, EVAR could improve these outcomes, especially if a bifurcated stent-graft is implanted.

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