Endovascular treatment possible in ruptured abdominal aortic aneurysm

Since 1996 we have performed endovascular treatment (EVAR, endovascular aortic aneurysm repair) for elective abdominal aortic aneurysms (AAA) and since 2001 also for ruptured AAA (rAAA). All patients who were treated for rAAA during the period May 2001-January 2004 were retrospectively studied. Mortality was defined as 30-day mortality or hospital mortality when the hospital stay exceeded 30 days. 50 patients had rAAA, nine of them were not operated upon. 26 patients had open surgery, 15 had EVAR. Five risk predictors according to Hardman (age >76 years, loss of consciousness, Hb 90 g/l, creatinine level >0.19 mmol/l and electrocardiographic ischemia) as well as shock (BP <80 mm Hg) were registered. The mortality among the patients after open surgery was 46% and after EVAR 13%. By considering risk factors and shock a multivariate analysis resulted in OR = 6.5 (95% CI: 0.8-96; p = 0.079), supporting that any selection of the material had not influenced the result. We conclude that it is possible to treat rAAA with EVAR. Hypotensive patients can, at least initially, be operated under local anaesthesia with stabilization of blood pressure utilizing a percutaneously inserted occlusion balloon. Further studies are required to conclude whether EVAR significantly increases survival and reduces complications.