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Although there has been a remarkable improvement in the mortality rates of patients with ruptured abdominal aortic aneurysm (RAAA), debate remains with regard to the benefit of endovascular repair (EVAR) versus open surgical repair (OSAR) for patients with RAAA. The purpose of this study was to evaluate and compare contemporary outcomes for patients who received either OSAR or EVAR for RAAA in a Chinese tertiary vascular referral centre.
From January 1985 to May 2015, patients diagnosed with RAAA and treated with either EVAR or OSAR in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The primary outcome measures for our analysis were 30-day postoperative mortality, operative mortality, 30-day overall complication rate, readmission rates and hospital length of stay. Data were exported to IBM SPSS version 21 for statistical analysis with p < 0.05 considered significant.
Of the 126 patients with RAAA, 82 (65.1%) underwent OSAR and 44 (34.9%) EVAR. On multivariate regression, the likelihood of dying in the hospital after OSAR compared to EVAR was significantly greater (odds ratio [OR] = 1.84; 95% confidence interval [CI] = 1.68-2.11). There was significantly greater frequency of postoperative complications after OSAR compared to EVAR (OR = 1.97, 95%CI = 1.89-2.23, P < 0.001). Freedom from readmission after OSAR was significantly greater than that after EVAR. Hospital length of stay were shorter in EVAR compared to OSAR (P < 0.001).
Peri-operative survival benefit has been shown for EVAR of RAAA when compared with OSAR in this data. It also suggest that EVAR is associated with less hospital length of stay and fewer postoperative complications. In clinical settings where adequate resources, personnel, and surgical expertise are present, we suggest an endovascular approach should be strongly considered for all RAAA patients with acceptable anatomy.