Endovascular repair safer for ruptured aneurysms

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A study published in the April issue of the Journal of Vascular Surgery examines the national frequency, predictors, outcomes, and the effect of institutional volume metrics in cases where endovascular aortic repair was used to repair ruptured abdominal aortic aneurysms between 2001 and 2006.

Over the years, endovascular repair has gained wide acceptance for the elective treatment of abdominal aortic aneurysms. This success has led to increased interest in similar treatment of ruptured aneurysms, because most patients who suffer a ruptured aneurysm do not survive long enough to obtain medical care.

 

The mortality rate for patients who do survive and undergo traditional open surgical repair continues to exceed 40%.


In this study, an estimated 27,750 hospital discharges for ruptured aneurysm occurred, of which 11.55% were treated with endovascular repair. Data was secured through the Nationwide Inpatient Sample to evaluate operative outcomes.

“While the incidence of ruptured abdominal aortic aneurysm remained fairly constant, endovascular repair was used to treat ruptured aneurysm in an increasing proportion of patients – from 5.9% in 2001 to 18.9% in 2006,” said Andres Schanzer, assistant professor of surgery, University of Massachusetts Memorial Medical Center’s division of vascular and endovascular surgery, Worcester, USA.

 

Researchers found that endovascular repair was independently associated with a lower postoperative mortality risk than was open repair (31.7% vs. 40.7%).


“Elective surgery was the strongest predictor of the use of endovascular repair for ruptured aneurysm repairs,” added Schanzer. “The use of endovascular repair for ruptured aneurysm also increased in patients more than 80 years of age.

 

“Additionally, endovascular repair patients had a shorter length of stay (11.1 vs. 13.8 days for open repair); more discharges to home (65.1% vs. 53.9%); and lower hospital charges (US$108,672 vs. US$114,784).”


Procedure volume was determined for each institution where hospitals were categorised as low, medium or high volume. Researchers noted that even after adjustment for hospital surgical volume characteristics, teaching hospitals continued to show lower mortality risks following ruptured aneurysm repair than nonteaching hospitals.


Schanzer said that the study results support regionalisation of ruptured aneurysm repair to high volume centres whenever possible, and a wider adoption of endovascular repair nationwide. “Through such a system, appropriate patients could be rapidly transferred to institutions with endovascular capabilities, thus potentially decreasing the in-hospital mortality rate for this critically ill patient population,” he added.

 


Journal of Vascular Surgery