PMID- 25752694
OWN - NLM
STAT- MEDLINE
DCOM- 20150803
LR  - 20150525
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 61
IP  - 6
DP  - 2015 Jun
TI  - In patients stratified by preoperative risk, endovascular repair of ruptured 
      abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than 
      open repair.
PG  - 1399-407
LID - S0741-5214(15)00152-4 [pii]
LID - 10.1016/j.jvs.2015.01.042 [doi]
AB  - OBJECTIVE: Previous studies have reported that endovascular repair (EVAR) of 
      ruptured abdominal aortic aneurysms (RAAAs) has lower postoperative mortality 
      than open repair (OR). However, comparisons involved heterogeneous populations 
      that lacked adjustment for preoperative risk. We hypothesize that for RAAA 
      patients stratified by a validated measure of preoperative mortality risk, EVAR 
      has a lower in-hospital mortality and morbidity than does OR. METHODS: 
      In-hospital mortality and morbidity after EVAR and OR of RAAA were compared in 
      patients from the Vascular Quality Initiative (2003-2013) stratified by the 
      validated Vascular Study Group of New England RAAA risk score into low-risk 
      (score 0-1), medium-risk (score 2-3), and high-risk (score 4-6) groups. RESULTS: 
      Among 514 patients who underwent EVAR and 651 patients who underwent OR of RAAA, 
      EVAR had lower in-hospital mortality (25% vs 33%, P = .001). In risk-stratified 
      patients, EVAR trended toward a lower mortality in the low-risk group (n = 626; 
      EVAR, 10% vs OR, 15%; P = .07), had a significantly lower mortality in the 
      medium-risk group (n = 457; EVAR, 37% vs OR, 48%; P = .02), and no advantage in 
      the high-risk group (n = 82; EVAR, 95% vs OR, 79%; P = .17). Across all risk 
      groups, cardiac complications (EVAR, 29% vs OR, 38%; P = .001), respiratory 
      complications (EVAR, 28% vs OR, 46%; P < .0001), renal insufficiency (EVAR, 24% 
      vs OR, 38%; P < .0001), lower extremity ischemia (EVAR, 2.7% vs OR, 8.1%; P < 
      .0001), and bowel ischemia (EVAR, 3.9% vs OR, 10%; P < .0001) were significantly 
      lower after EVAR than after OR. Across all risk groups, median (interquartile 
      range) intensive care unit length of stay (EVAR, 2 [1-5] days vs OR, 6 [3-13] 
      days; P < .0001) and hospital length of stay (EVAR, 6 [4-12] days vs OR, 13 
      [8-22] days; P < .0001) were lower after EVAR. CONCLUSIONS: This novel 
      risk-stratified comparison using a national clinical database showed that EVAR of 
      RAAA has a lower mortality and morbidity compared with OR in low-risk and 
      medium-risk patients and that EVAR should be used to treat these patients when 
      anatomically feasible. For RAAA patients at the highest preoperative risk, there 
      is no benefit to using EVAR compared with OR.
CI  - Copyright (c) 2015 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Ali, Mujtaba M
AU  - Ali MM
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass.
FAU - Flahive, Julie
AU  - Flahive J
AD  - Center for Outcomes Research, Department of Surgery, University of Massachusetts 
      Medical School, Worcester, Mass.
FAU - Schanzer, Andres
AU  - Schanzer A
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass.
FAU - Simons, Jessica P
AU  - Simons JP
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass.
FAU - Aiello, Francesco A
AU  - Aiello FA
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass.
FAU - Doucet, Danielle R
AU  - Doucet DR
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass.
FAU - Messina, Louis M
AU  - Messina LM
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass.
FAU - Robinson, William P
AU  - Robinson WP
AD  - Division of Vascular & Endovascular Surgery, University of Massachusetts Medical 
      School, Worcester, Mass. Electronic address: william.robinson@umassmemorial.org.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20150307
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2015 Jun;61(6):1406-7. PMID: 25752689
MH  - Aged
MH  - Aortic Aneurysm, Abdominal/diagnosis/mortality/*surgery
MH  - Aortic Rupture/diagnosis/mortality/*surgery
MH  - Blood Vessel Prosthesis Implantation/*adverse effects/*mortality
MH  - Chi-Square Distribution
MH  - Databases, Factual
MH  - Endovascular Procedures/*adverse effects/*mortality
MH  - Female
MH  - *Hospital Mortality
MH  - Humans
MH  - Length of Stay
MH  - Logistic Models
MH  - Male
MH  - Odds Ratio
MH  - Postoperative Complications/*mortality/therapy
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2015/03/11 06:00
MHDA- 2015/08/04 06:00
CRDT- 2015/03/11 06:00
PHST- 2014/09/12 00:00 [received]
PHST- 2015/01/21 00:00 [accepted]
PHST- 2015/03/11 06:00 [entrez]
PHST- 2015/03/11 06:00 [pubmed]
PHST- 2015/08/04 06:00 [medline]
AID - S0741-5214(15)00152-4 [pii]
AID - 10.1016/j.jvs.2015.01.042 [doi]
PST - ppublish
SO  - J Vasc Surg. 2015 Jun;61(6):1399-407. doi: 10.1016/j.jvs.2015.01.042. Epub 2015 
      Mar 7.