TAO of ruptured aneurysm repair

An interesting finding in the report by D’Oria et al 1 D’Oria M. Scali S.T. Neal D. DeMartino R. Beck A.W. Mani K. et al. Center volume and failure to rescue after open or endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2022; 76: 1565-1576 Abstract Full Text Full Text PDF Scopus (4) Google Scholar was that low-volume facilities had similar results after repair of ruptured abdominal aortic aneurysm using endovascular abdominal aortic aneurysm repair (EVAR) as larger high-volume facilities. 1 D’Oria M. Scali S.T. Neal D. DeMartino R. Beck A.W. Mani K. et al. Center volume and failure to rescue after open or endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2022; 76: 1565-1576 Abstract Full Text Full Text PDF Scopus (4) Google Scholar The Tao teaches us "everything is connected, and nothing makes sense by itself." 2 Lau D.C. Lao Tzu: Tao Te Ching. Penguin Books, 1963 Google Scholar Although there has been debate about EVAR for ruptures since the first series reported by Veith et al, 3 Veith F.J. Ohki T. Lipsitz E.C. Suggs W.D. Cynamon J. Endovascular grafts and other catheter-directed techniques in the management of ruptured abdominal aortic aneurysms. Semin Vasc Surg. 2003; 16: 326-331 Crossref PubMed Scopus (60) Google Scholar most have strongly advocated for EVAR as primary therapy for a ruptured abdominal aortic aneurysm (rAAA) if the patient’s anatomy permits. 4 Mehta M. Taggert J. Darling III, R.C. Chang B.B. Kreienberg P.B. Paty P.S.K. et al. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg. 2006; 44: 1-8 Abstract Full Text Full Text PDF PubMed Scopus (241) Google Scholar However, it would be folly to assume that EVAR for a rAAA in and of itself will be the best solution in all hospitals. Center volume and failure to rescue after open or endovascular repair of ruptured abdominal aortic aneurysmsJournal of Vascular SurgeryVol. 76Issue 6PreviewThe correlation between center volume and elective abdominal aortic aneurysm (AAA) repair outcomes is well established; however, these effects for either endovascular aneurysm repair (EVAR) or open aneurysm repair (OAR) of ruptured AAA (rAAA) remains unclear. Notably, the capacity to either avert or manage complications associated with postoperative mortality is an important cause of outcome disparities after elective procedures; however, there is a paucity of data surrounding nonelective presentations. Full-Text PDF