Tratamiento del aneurisma de aorta abdominal roto: ¿EVAR o cirugía abierta?

Introduction: Rupture of abdominal aortic aneurysm (rAAA) remains a major challenge for the vascular surgeon.The aim of this study is to analyze the results in the management of patients with rAAA, comparing open surgery (OS) and endovascular surgery (EVAR), as well as identifying prognostic factors.Material and methods: A study was conducted on two cohorts with rAAA, one treated with open surgery and another treated with EVAR. Patients admitted for rAAA were included consecutively. Baseline and clinical variables, risk factors, surgical time, morbidity and mortality were analyzed. Surgical intervention (SI) performed depended on surgeon preference and anatomical and clinical characteristics of the patients.Results: A total of 45 surgical procedures were performed between January 2003 and December 2013, 25 (56%) using OS and 20 (44%) using EVAR. The overall peri-operative mortality (<30 days) was 64% in OS and 50% in EVAR, with no significant differences in survival between the two groups (P=.141). Hemodynamic instability is the only variable with an impact on survival, hazard ratio 6.145 (IC 95%. 2.034-18.559; P=.001). In hemodynamically stable patients, mortality was 50% for OS and 15.4% for EVAR; no differences were observed between the groups (P=.1).Conclusions: Although there were no statistically significant differences between the 2 groups, better results with an important clinical relevance were observed in the EVAR group.Hemodynamic instability was the only prognostic factor found, multiplying mortality by (C) 2014SEACV. Published by Elsevier Espana, S.L.U. All rights reserved.