An intention-to-treat by endovascular repair policy may reduce overall mortality in ruptured abdominal aortic aneurysm
| Autor: | Ragai R. Makar, L.L. Lau, Bernard Lee, Chee V. Soong, William Loan, R.J. Hannon, Nityanand Arya |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Aneurysm Ruptured Endovascular aneurysm repair law.invention Aortic aneurysm Blood Vessel Prosthesis Implantation Aneurysm Postoperative Complications law medicine Humans Hospital Mortality Aged Intention-to-treat analysis Ruptured abdominal aortic aneurysm business.industry Mortality rate Patient Selection Acute Kidney Injury Length of Stay medicine.disease Intensive care unit Surgery Female business Tomography X-Ray Computed Cardiology and Cardiovascular Medicine Vascular Surgical Procedures Abdominal surgery Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Vascular Surgery. 44(3):467-471 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2006.05.013 |
| Popis: | Objective The use of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) has been restricted to a small number of specialized units on a selected group of patients. The aim of this study is to assess if the overall mortality in these patients with ruptured AAA may be reduced in a unit where all patients with ruptured AAA are considered first for EVAR. Methods During a 24-month period beginning in July 2002, 51 patients admitted with ruptured AAA were considered for EVAR as the treatment of choice and comprised the study group. EVAR was performed in 17 patients. Open repair was performed in 34 patients: 13 patients had hemodynamic instability and 16 patients had an unsuitable aortic neck anatomy. The study group was compared with a historical control group of 41 patients with ruptured AAA who were treated by open repair from July 2000 to June 2002. Results Mortality rate was 39% in the study group compared with 59% in the control group (P = .065). The duration of stay in the intensive care unit was significantly lower in the study group than in the control group (P = .01), although the total in-hospital stay was similar (17 days vs 14 days, P = .83). Within the study group, EVAR patients had a mortality rate of 24% compared with 47% in the open group (P = .14). Conclusion Although the number of patients was small, offering EVAR to as many patients as possible with ruptured AAA has resulted in a 20% reduction in mortality, albeit statistically insignificant. However, it is in the unstable patients that EVAR will need to improve survival before it may be hailed to supersede the conventional approach. |
| Databáze: | OpenAIRE |
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