M. Pherson2, J. Richman2, A. Beck1, E. Spangler1 1University Of Alabama At Birmingham,Department Of Surgery, Division Of Vascular Surgery And Endovascular Therapy,Birmingham, AL, USA 2Univiersity Of Alabama At Birmingham,Department Of Surgery,Birmingham, AL, USA
Introduction: Endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) has evolved over the past 10 years to become a feasible treatment mechanism with potentially decreased morbidity and mortality for patients with appropriate anatomy. On an institutional basis, reports of similar rates of abdominal compartment syndrome were found following creation of EVAR protocols for treatment of ruptured AAAs, but with overall decreased mortality. We seek to examine EVAR use over time and outcomes of abdominal evacuation in EVAR for rupture in clinical practice as assessed by a national vascular quality database.
Methods: Registry data on open AAA and EVAR repairs from 2003-2016 in the Vascular Quality Initiative (VQI) were obtained (a total of 40,450 procedures). Our cohort was then restricted to the 3,424 cases where rupture was the indication for repair. This cohort was analyzed for change in use of modality of repair over time, variation in repair use by region (clustered into North, South, East and West), and survival outcomes by modality of repair. Comparisons of demographics were performed via ANOVA and chi squared analyses as indicated, and time to event analyses included Kaplan Meier curves and log rank testing.
Results: In total from 2003-2016, 3424 rupture repairs were performed within the VQI: 1605 open repairs and 1819 EVAR repairs. Of the EVAR repairs, 1597 were performed without abdominal evacuation, while 222 required abdominal evacuation. Trends in modality of repair over time showed a distinct rise in utilization of any form of EVAR repair from none in 2003 to above 60% of repairs by 2016. No significant variation in use of EVAR by geographic region (north, south, east or west) was seen. As seen in Figure 1, EVAR repairs not requiring abdominal evacuation had the greatest survival, while EVAR repairs requiring abdominal evacuation had a lower survival than open AAA repair.
Factors which were significantly different in the group requiring abdominal evacuation included age (p=.01), and intraoperative packed red blood cell transfusion (p=.02). However, the percentage of patients considered unfit for open repair did not differ significantly between patients receiving or not receiving abdominal exploration (28.5% vs 26.2%, p=.48).
Conclusion: EVAR use has increased over time, however the proportion undergoing abdominal evacuation has remained relatively stable. Patients requiring abdominal evacuation after EVAR fared worse than those undergoing EVAR repair without abdominal evacuation or open AAA repair, likely as a surrogate for occurrence of abdominal compartment syndrome.
