Transition from Open Repair to Endovascular Aneurysm Repair for Rupture Aortic Aneurysms throughout a 16-Year Period of Time in a Single Tertiary Center

BACKGROUND:Endovascular aneurysm repair (EVAR) is recommended as a first option for both elective and ruptured abdominal aortic aneurysms (rAAAs) with suitable anatomy. The aim of this study was to evaluate the outcomes of the gradual adoption of rEVAR as first option in the management of rAAAs in a reference tertiary center over a 16 year-period. METHODS:A retrospective analysis of prospectively collected clinical data was undertaken, including all patients that were treated for rAAA infrarenal or juxtarenal either with open surgical repair (OSR) or EVAR from 2006 to 2023. Three periods were identified and analyzed: Initial (2006-2011); Intermediate (2012-2017) and Current (2018-2023). The primary outcomes were the 30-day mortality rate in relation to the changing pattern of treatment. Secondary outcomes were re-intervention and mortality during the follow up period. RESULTS:Two hundred patients were treated for rAAA; 52% by endovascular means [EVAR (94), Ch-EVAR (9), BEVAR (1)] and 48% by OSR (96). In initial period 61 patients were treated for rAAA (21% EVAR vs 79% OSR), 68 in intermediate patients (47% EVAR vs 53% OSR) and 71 in current period (83% EVAR vs 17% OSR). Only in the current period juxta -renal rAAAs were treated by endovascular means (14%). The 30-day mortality rate was 46% in initial period (31% for EVAR vs 50% for OSR), 64% in second period (46% in EVAR vs 80% for OSR) and 35% in third period (25% for EVAR vs 83% for OSR). The mean follow up did not differ between the groups, (EVAR 28.3±2 months, vs. OSR 33.1±3 months, p=0.56). The survival rate did not differ between the groups; in rEVAR was 82% (SE 5%), 74% (SE 6%), 68% (SE 6.5%) and 63% (SE 7.7%) at 12, 24, 36 and 48 months, respectively, and in OSR was 76% (SE 7%), 66% (SE 8%), and 56% (SE 9.5%) at 6, 24 and 48 months, respectively (p=0.544) CONCLUSION: Through a 16-year period, the implementation of EVAR as treatment of choice for rAAAs over OSR resulted in a noticeable reduction in the 30-day mortality. rEVAR was feasible in over 80% of rAAA patients.