Comparative Analysis On The Surgical Treatment For Ruptured Abdominal Aortic Aneurysm

Background: Ruptured abdominal aortic aneurysm (rAAA) is a severe andfatal complication of abdominal aortic aneurysm (AAA). Early open surgicalrepair (OSR) has long been considered as the standard treatment for rAAA.Endovascular aortic repair (EVAR) can decrease the perioperative mortalityand complications in the elective AAA treatment. Chinese and internationalscholars gradually attempted EVAR for rAAA treatment in recent two decades.But advantage and disadvantage between OSR and EVAR are inconlusive.More adequate evidences are needed to support EVAR for rAAA treatment.Purpose:1.Systematic review the comparative study on EVAR and OARfor rAAA treatment, and compare the perioperative mortality, blood loss,blood transfusion, infusion quantity, length of procedure and hospital staybetween EVAR and OSR.2. To review rAAA cases underwent emergentsurgery from February2002to February2013in PUMCH.Methods:1. Systematic review: We searched the PubMed (1994.01～2013.10) for English published comparative studies about EVAR and OSRtreatment for rAAA by key words “abdominal aortic aneurysm” AND“ruptured”AND “endovascular”, qualitatively evaluate the studies based on theprinciples of systematic review.2. A single-center study: retrospectively reviewthe clinical data of28rAAA cases underwent emergent surgery from February 2002to February2013in PUMCH，and compare the clinical outcomes andperioperative mortality between OSR and EVAR.Results:1. Systematic review: The searches identified31relevant studies,2RCT studies and29non-RCT studies. A total of42038cases were included.Non-RCT studies demonstrated EVAR can decrease the perioperative mortalitywith the average mortality of22.5%(0-53%) and OSR of37.3%(12.5%-70%).EVAR indicated less blood loss, blood and fluid intake, also can shorten theoperation time, hospital and ICU stay. However, RCT studies didn’t showabsolute advantages in EVAR treatment for rAAA when compared with OSR.2. A single-center study: EVAR group demonstrated lower30-day mortality(0vs.33.3%), lower blood loss（172vs.4023ml; P=0.005）, blood transfusion（631vs.2092ml; P=0.003）and infusion quantity (2085vs.4192ml; P<0.001）,and shorter length of procedure（166.9vs.292.5min; P=0.001）and hospitalsta（y14.2vs.19.2d;P=0.02）. EVAR had no severe perioperative complicationsand showed superior1-year follow-up survival (84.6%vs53.8%).Conclusions:1. EVAR is a safe and effective treatment for rAAA. Werecommend EVAR as the first-line treatment for EVAR, especially for the aged.2. Increasing non-RCT studies identified the efficacy of EVAR in proper rAAApatients, but now no RCT showed absolute advantages of EVAR over OSR.We need more evidence-based studies to support EVAR treatment for rAAA.