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Endovascular (EVAR) versus Open Surgical Repair (OSR): A Seven Year Retrospective Review of Ruptured Abdominal Aortic Aneurysm (rAAA) Repair in a Community Hospital Setting
*Muhammad T Rishi, Alexander Palesty
Saint Marys Hospital, Waterbury, CT
Objective: Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has shown benefit over open surgical repair(OSR) in several large institutional trials; however there is a paucity of data from small community hospitals. Our objective is to perform a retrospective analysis of EVAR vs. OSR in patients with rAAA in a community hospital setting.
Design: Retrospective chart review. Setting: Community Hospital. Patients:From 2007 until 2013, all patients who presented with rAAA and underwent surgical intervention were included in this study (N=10; 5/group).
Interventions: Patients presenting with rAAA underwent either OSR or EVAR depending upon aneurysm characteristics, and patient factors.
Main Outcome Measures: Primary Objective: Thirty day survival; Secondary Objectives: Intra-operative mortality.
Results: Average patient age did not differ [OSR- 76.4±4.34years (N=5) vs. EVAR 80.80±2.85years (N=5); p>0.05]. Mean aneurismal size was also not different [OSR-6.94±1.04cm (N=5) vs. EVAR-7.84±0.58cm (N=5); p>0.05]. Male to female distribution in both OSR and EVAR groups was 3:2. Preoperative risk factors for both groups were similar. EVAR showed a 40% increased intraoperative mortality; however it did not reach statistical significance [Odds Ratio=0.12; p>0.05]. Thirty-day survival of OSR group was significantly higher than EVAR group [21±5.82days (N=5) vs. 4.40±3.23days ( N=5); p<0.05](Graph 1).
Conclusions: This study shows that patients who underwent OSR for rAAA had significantly increased 30-day survival when compared to EVAR. This indicates that in setting of rAAA, EVAR should be reserved for centers that have an experienced endovascular team. Our limitations included a single institutional study with a small sample size and shorter follow up.
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