Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair

Naveed Saqib, Sun Cheol Park, Taeyoung Park, Robert Y. Rhee, Rabih A. Chaer, Michel S. Makaroun, Jae Sung Cho

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Endovascular repair of ruptured abdominal aortic aneurysm (rAAA) is being increasingly performed despite lack of good evidence for its superiority. Other reported studies suffer from patient selection and publication bias with limited follow-up. This study is a single-center propensity score comparing early and midterm outcomes between open surgical repair (OSR) and endovascular repair of rAAA (REVAR). A retrospective review from January 2001 to November 2010 identified 312 patients who underwent rAAA repairs. Thirty-one patients with antecedent AAA repair and three with incomplete records were excluded, leaving 37 REVARs and 241 OSRs. Propensity score-based matching for sex, age, preoperative hemodynamic status, surgeon's annual AAA volume, and preoperative cardiopulmonary resuscitation was performed in a 1:3 ratio to compare outcomes. Thirty-seven REVARs were matched with 111 OSRs. Late survival was estimated by Kaplan-Meier methods. Operative time and blood replacement were higher with OSR. Overall complication rates were similar (54% REVAR vs 66% OSR; P = .23), except for higher incidences of tracheostomies (21% vs 3%; P = .015), myocardial infarction (38% vs 18%; P = .036), and acute tubular necrosis (47% vs 21%; P = .009) with OSR. Operative mortality rates were similar (22% REVAR vs 32% OSR), with an odds ratio of 0.63 for REVAR (95% confidence interval = [0.24, 1.48]; P = .40). No differences in the incidences for secondary interventions for aneurysm- or graft-related complications were noted (22% REVAR vs 22% OSR; P = .99). Kaplan-Meier estimates of 1-, 2-, and 3-year survival rates were also similar (50%, 50%, 42% REVAR vs 54%, 52%, 47% OSR; P = .66). REVAR for rAAA does not seem to conclusively confer either acute or late survival advantages. Routine use of REVAR should be deferred until prospective, randomized trial data become available.

Original languageEnglish
Pages (from-to)614-619
Number of pages6
JournalJournal of Vascular Surgery
Volume56
Issue number3
DOIs
Publication statusPublished - 2012 Sep 1

Fingerprint

Aortic Rupture
Abdominal Aortic Aneurysm
Propensity Score
Survival
Pyridinolcarbamate
Publication Bias
Selection Bias
Tracheostomy
Incidence
Cardiopulmonary Resuscitation
Kaplan-Meier Estimate
Operative Time
Patient Selection
Aneurysm
Necrosis
Survival Rate
Hemodynamics
Odds Ratio
Myocardial Infarction
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Saqib, Naveed ; Park, Sun Cheol ; Park, Taeyoung ; Rhee, Robert Y. ; Chaer, Rabih A. ; Makaroun, Michel S. ; Cho, Jae Sung. / Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair. In: Journal of Vascular Surgery. 2012 ; Vol. 56, No. 3. pp. 614-619.
@article{e5b051efe822460eab53412c63e3e7ad,
title = "Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair",
abstract = "Endovascular repair of ruptured abdominal aortic aneurysm (rAAA) is being increasingly performed despite lack of good evidence for its superiority. Other reported studies suffer from patient selection and publication bias with limited follow-up. This study is a single-center propensity score comparing early and midterm outcomes between open surgical repair (OSR) and endovascular repair of rAAA (REVAR). A retrospective review from January 2001 to November 2010 identified 312 patients who underwent rAAA repairs. Thirty-one patients with antecedent AAA repair and three with incomplete records were excluded, leaving 37 REVARs and 241 OSRs. Propensity score-based matching for sex, age, preoperative hemodynamic status, surgeon's annual AAA volume, and preoperative cardiopulmonary resuscitation was performed in a 1:3 ratio to compare outcomes. Thirty-seven REVARs were matched with 111 OSRs. Late survival was estimated by Kaplan-Meier methods. Operative time and blood replacement were higher with OSR. Overall complication rates were similar (54{\%} REVAR vs 66{\%} OSR; P = .23), except for higher incidences of tracheostomies (21{\%} vs 3{\%}; P = .015), myocardial infarction (38{\%} vs 18{\%}; P = .036), and acute tubular necrosis (47{\%} vs 21{\%}; P = .009) with OSR. Operative mortality rates were similar (22{\%} REVAR vs 32{\%} OSR), with an odds ratio of 0.63 for REVAR (95{\%} confidence interval = [0.24, 1.48]; P = .40). No differences in the incidences for secondary interventions for aneurysm- or graft-related complications were noted (22{\%} REVAR vs 22{\%} OSR; P = .99). Kaplan-Meier estimates of 1-, 2-, and 3-year survival rates were also similar (50{\%}, 50{\%}, 42{\%} REVAR vs 54{\%}, 52{\%}, 47{\%} OSR; P = .66). REVAR for rAAA does not seem to conclusively confer either acute or late survival advantages. Routine use of REVAR should be deferred until prospective, randomized trial data become available.",
author = "Naveed Saqib and Park, {Sun Cheol} and Taeyoung Park and Rhee, {Robert Y.} and Chaer, {Rabih A.} and Makaroun, {Michel S.} and Cho, {Jae Sung}",
year = "2012",
month = "9",
day = "1",
doi = "10.1016/j.jvs.2012.01.081",
language = "English",
volume = "56",
pages = "614--619",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "3",

}

Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair. / Saqib, Naveed; Park, Sun Cheol; Park, Taeyoung; Rhee, Robert Y.; Chaer, Rabih A.; Makaroun, Michel S.; Cho, Jae Sung.

In: Journal of Vascular Surgery, Vol. 56, No. 3, 01.09.2012, p. 614-619.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair

AU - Saqib, Naveed

AU - Park, Sun Cheol

AU - Park, Taeyoung

AU - Rhee, Robert Y.

AU - Chaer, Rabih A.

AU - Makaroun, Michel S.

AU - Cho, Jae Sung

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Endovascular repair of ruptured abdominal aortic aneurysm (rAAA) is being increasingly performed despite lack of good evidence for its superiority. Other reported studies suffer from patient selection and publication bias with limited follow-up. This study is a single-center propensity score comparing early and midterm outcomes between open surgical repair (OSR) and endovascular repair of rAAA (REVAR). A retrospective review from January 2001 to November 2010 identified 312 patients who underwent rAAA repairs. Thirty-one patients with antecedent AAA repair and three with incomplete records were excluded, leaving 37 REVARs and 241 OSRs. Propensity score-based matching for sex, age, preoperative hemodynamic status, surgeon's annual AAA volume, and preoperative cardiopulmonary resuscitation was performed in a 1:3 ratio to compare outcomes. Thirty-seven REVARs were matched with 111 OSRs. Late survival was estimated by Kaplan-Meier methods. Operative time and blood replacement were higher with OSR. Overall complication rates were similar (54% REVAR vs 66% OSR; P = .23), except for higher incidences of tracheostomies (21% vs 3%; P = .015), myocardial infarction (38% vs 18%; P = .036), and acute tubular necrosis (47% vs 21%; P = .009) with OSR. Operative mortality rates were similar (22% REVAR vs 32% OSR), with an odds ratio of 0.63 for REVAR (95% confidence interval = [0.24, 1.48]; P = .40). No differences in the incidences for secondary interventions for aneurysm- or graft-related complications were noted (22% REVAR vs 22% OSR; P = .99). Kaplan-Meier estimates of 1-, 2-, and 3-year survival rates were also similar (50%, 50%, 42% REVAR vs 54%, 52%, 47% OSR; P = .66). REVAR for rAAA does not seem to conclusively confer either acute or late survival advantages. Routine use of REVAR should be deferred until prospective, randomized trial data become available.

AB - Endovascular repair of ruptured abdominal aortic aneurysm (rAAA) is being increasingly performed despite lack of good evidence for its superiority. Other reported studies suffer from patient selection and publication bias with limited follow-up. This study is a single-center propensity score comparing early and midterm outcomes between open surgical repair (OSR) and endovascular repair of rAAA (REVAR). A retrospective review from January 2001 to November 2010 identified 312 patients who underwent rAAA repairs. Thirty-one patients with antecedent AAA repair and three with incomplete records were excluded, leaving 37 REVARs and 241 OSRs. Propensity score-based matching for sex, age, preoperative hemodynamic status, surgeon's annual AAA volume, and preoperative cardiopulmonary resuscitation was performed in a 1:3 ratio to compare outcomes. Thirty-seven REVARs were matched with 111 OSRs. Late survival was estimated by Kaplan-Meier methods. Operative time and blood replacement were higher with OSR. Overall complication rates were similar (54% REVAR vs 66% OSR; P = .23), except for higher incidences of tracheostomies (21% vs 3%; P = .015), myocardial infarction (38% vs 18%; P = .036), and acute tubular necrosis (47% vs 21%; P = .009) with OSR. Operative mortality rates were similar (22% REVAR vs 32% OSR), with an odds ratio of 0.63 for REVAR (95% confidence interval = [0.24, 1.48]; P = .40). No differences in the incidences for secondary interventions for aneurysm- or graft-related complications were noted (22% REVAR vs 22% OSR; P = .99). Kaplan-Meier estimates of 1-, 2-, and 3-year survival rates were also similar (50%, 50%, 42% REVAR vs 54%, 52%, 47% OSR; P = .66). REVAR for rAAA does not seem to conclusively confer either acute or late survival advantages. Routine use of REVAR should be deferred until prospective, randomized trial data become available.

UR - http://www.scopus.com/inward/record.url?scp=84865235629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865235629&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2012.01.081

DO - 10.1016/j.jvs.2012.01.081

M3 - Article

VL - 56

SP - 614

EP - 619

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 3

ER -