Percutaneous endovascular repair of ruptured abdominal aortic aneurysms

Hypothesis: Percutaneous endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) has better outcomes than traditional open surgical repair. Design: Single-center retrospective review. Setting: University hospital tertiary referral center. Patients: Thirty-seven RAAAs treated using endovascular repair (n=15) or open surgery (n=22). Interventions: From January 1, 2000, through December 31, 2005, 15 RAAAs were treated with endovascular stent graft exclusion using commercially available systems. Twenty-two other patients undergoing standard open surgical repair during the same interval comprised a control group for comparison. Main Outcome Measures: Early outcomes of percutaneous endovascular repair of RAAAs. Results: Among the endovascular group, the mean±SD age was 73±9.8 years, 86.6% were men (n=13), and 20.0% had a preoperative systolic blood pressure of 80 mm Hg or lower (n=3). An entirely percutaneous procedure was performed in the final 11 patients using arterial closure systems. Technical success of attempted endovascular exclusion was 100.0%. The mean±SD procedure time (107±30 minutes), transfusion requirements (6.6±4.7 U), and length of stay (3.0±6.8 days) were statistically significantly reduced compared with open surgery. The 30-day mortality was 6.7% (1 of 15) compared with an open surgery 30-day mortality of 13.6% (3 of 22). No late complications (pseudoaneurysm, infection, lymphocele, or neuropathy) occurred after a completely percutaneous technique during a mean follow-up of 12 months. Conclusion: Percutaneous endovascular repair of RAAAs is a more expedient and less morbid alternative than open surgical repair.