PMID- 26916581
OWN - NLM
STAT- MEDLINE
DCOM- 20160706
LR  - 20160226
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 63
IP  - 3
DP  - 2016 Mar
TI  - Endovascular repair of ruptured abdominal aortic aneurysms does not reduce later 
      mortality compared with open repair.
PG  - 617-24
LID - S0741-5214(15)02017-0 [pii]
LID - 10.1016/j.jvs.2015.09.057 [doi]
AB  - OBJECTIVE: Endovascular aneurysm repair (EVAR) of ruptured abdominal aortic 
      aneurysms (RAAAs) reduces in-hospital mortality compared with open repair (OR), 
      but it is unknown whether EVAR reduces long-term mortality. We hypothesized that 
      EVAR of RAAA would independently reduce long-term mortality compared with OR. 
      METHODS: The Vascular Quality Initiative database (2003-2013) was used to 
      determine Kaplan-Meier 1-year and 5-year mortality after EVAR and OR of RAAA. 
      Multivariate analysis was performed to identify patient and operative 
      characteristics associated with mortality at 1 year and 5 years after RAAA 
      repair. RESULTS: Among 590 patients who underwent EVAR and 692 patients who 
      underwent OR of RAAA, the lower mortality seen in the hospital after EVAR (EVAR 
      23% vs OR 35%; P < .001) persisted at 1 year (EVAR 34% vs OR 42%; P = .001) and 5 
      years (EVAR 50% vs OR 58%; P = .003) after repair. After adjusting for patient 
      and operative characteristics, EVAR did not independently reduce mortality at 1 
      year (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.7-1.1) or 5 years 
      (HR, 0.95; 95% CI, 0.77-1.2) compared with OR. Dialysis dependence (HR, 3.9; 95% 
      CI, 1.8-8.6), home oxygen use (HR, 1.9; 95% CI, 1.3-2.7), cardiac ejection 
      fraction <50% (HR, 1.5; 95% CI, 1.03-2.1), female gender (HR, 1.3; 95% CI, 
      1.04-1.6), and age (HR, 1.06; 95% CI, 1.05-1.08 per 5 years) as well as cardiac 
      arrest (HR, 3.4; 95% CI, 2.5-4.5), loss of consciousness (HR, 1.7; 95% CI, 
      1.3-2.2), and preoperative systolic blood pressure <90 mm Hg (HR, 1.4; 95% CI, 
      1.1-1.8) on admission predicted mortality at 1 year and 5 years after RAAA 
      repair. Type I endoleak (HR, 2.2; 95% CI, 1.2-3.8) also predicted mortality at 1 
      year. CONCLUSIONS: EVAR does not independently reduce long-term mortality 
      compared with OR. Patient comorbidities and indices of shock on admission are the 
      primary independent determinants of long-term mortality. However, the lower early 
      mortality observed in the Vascular Quality Initiative for patients selected to 
      undergo EVAR of RAAA compared with patients selected for OR is sustained over 
      time, suggesting that EVAR for RAAA is beneficial in appropriate candidates. 
      Better elucidation of the key selection factors, including aneurysm anatomy, is 
      needed to best select patients for EVAR and OR to reduce long-term mortality.
CI  - Copyright (c) 2016 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Robinson, William P
AU  - Robinson WP
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School, Worcester, Mass. Electronic address: wprobins3@gmail.com.
FAU - Schanzer, Andres
AU  - Schanzer A
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School, Worcester, Mass.
FAU - Aiello, Francesco A
AU  - Aiello FA
AD  - Division of Vascular and 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 - Simons, Jessica P
AU  - Simons JP
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School, Worcester, Mass.
FAU - Doucet, Danielle R
AU  - Doucet DR
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School, Worcester, Mass.
FAU - Arous, Elias
AU  - Arous E
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School, Worcester, Mass.
FAU - Messina, Louis M
AU  - Messina LM
AD  - Division of Vascular and Endovascular Surgery, University of Massachusetts 
      Medical School, Worcester, Mass.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
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  - Comorbidity
MH  - Databases, Factual
MH  - Endovascular Procedures/adverse effects/*mortality
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Multivariate Analysis
MH  - North America/epidemiology
MH  - Patient Selection
MH  - Proportional Hazards Models
MH  - Risk Assessment
MH  - Risk Factors
MH  - Shock/mortality
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2016/02/27 06:00
MHDA- 2016/07/07 06:00
CRDT- 2016/02/27 06:00
PHST- 2015/07/27 00:00 [received]
PHST- 2015/09/29 00:00 [accepted]
PHST- 2016/02/27 06:00 [entrez]
PHST- 2016/02/27 06:00 [pubmed]
PHST- 2016/07/07 06:00 [medline]
AID - S0741-5214(15)02017-0 [pii]
AID - 10.1016/j.jvs.2015.09.057 [doi]
PST - ppublish
SO  - J Vasc Surg. 2016 Mar;63(3):617-24. doi: 10.1016/j.jvs.2015.09.057.