SIR: EVAR bests open aortic aneurysm repair

One true-positive aneurysm in 62-year-old woman. Volume-rendered digital subtraction CT angiographic image. Source: Radiology

Emergency endovascular aneurysm repair (EVAR) effectively treats potentially fatal ruptured aneurysms in the abdomen without major surgery, involves less recovery time and fewer discharges to inpatient care facilities, according to research presented March 27 at the annual meeting of the Society of Interventional Radiology in San Francisco.

"Prior to the development of minimally invasive endovascular repair, it was customary for individuals to undergo open surgery, but now the majority of these elective aneurysm repairs are being done by endovascular technique. It's only a question now of getting clinicians and institutions to use the same technique in emergency settings for ruptured aneurysms," Prasoon Mohan, MD, from the department of diagnostic and interventional radiology at Saint Francis Hospital in Evanston, Ill., said in a statement.

Mohan and colleagues devised a retrospective study to compare outcome parameters associated with EVAR and open aortic repairs for ruptured abdominal aortic aneurysms (AAA).

Researchers mined the National Inpatient Sample, part of the larger Healthcare Cost and Utilization Project, to find all cases of ruptured AAA from 2001 to 2009 treated by either endovascular repair or open surgery.

Mohan et al found that 38,858 individuals, with an average age of 74, had ruptured AAA and received one of these two treatments. Endovascular repair was used to treat 6,790 patients; 32,069 individuals had open surgery.

The researchers reported that 39.7 percent of patients who received open surgery died in the hospital, compared to 28.2 percent of patients who received EVAR. The average length of hospital stay for people who had EVAR was about 11 days, but those who received open surgery stayed almost 14 days. While 35 percent of patients were able to go home without requiring further inpatient rehabilitation after endovascular repair, only 22 percent of those who received open surgery were discharged to their homes.

Regardless of the type of repair, women had worse outcomes compared with men after the procedure. A total of 47 percent of women undergoing open repair died in the hospital compared with 37.5 percent of men. Among EVAR patients, in-hospital mortality was 32.3 percent for women and 27 percent for men.

"Endovascular aortic repair involves less recovery time and fewer discharges to inpatient care facilities, potentially saving insurers, institutions and individuals money," said Mohan.