Evaluation of Stent Graft First-Line Surgical Strategy for a Ruptured Abdominal Aneurysm

Jun Hayashi＊	Yoshinori Kuroda＊	Eiich Ohba＊
Masahiro Mizumoto＊	Atsushi Yamashita＊	Shingo Nakai＊
Kimihiro Kobayashi＊	Tomonori Ochiai＊	Tetsuro Uchida＊

（Second Department of Surgery, Faculty of Medicine, Yamagata University＊, Yamagata, Japan）

Objective:The availability of endovascular aneurysm repair（EVAR）has gradually increased the number of patients undergoing surgical treatment for ruptured abdominal aortic aneurysm（rAAA). The aim of this study was to evaluate our endovascular first-line surgical treatment strategy for rAAA. Methods:We retrospectively reviewed 35 consecutive patients who underwent emergent surgery for rAAA（including ruptured iliac artery aneurysms）between January 2013 and December 2020. The patients were divided according to surgical procedure:Open surgical repair and endovascular repair. Clinicopathological features, including the preoperative state, the choice of surgical procedure and postoperative morbidity and mortality, were compared between the groups. The surgical indication of EVAR was determined according to the same anatomical criteria used for elective operation. Results:About half of 17 patients（48.6%）were assigned to open repair and as many as 14 of them（82.4%）were excluded from the indication of endovascular treatment due to anatomical unsuitability, which included an extremely short proximal neck, severe aortic elongation and access route problems. Logistic regression analysis demonstrated that the patients with open surgery tended to have longer intubation times and higher incidences of post-operative temporal dialysis. There was no in-hospital death among the EVAR patients, while 5 deaths（29.4%）occurred among the open surgery patients（circulatory failure:2, pneumonia:1, ischemic enteritis:1, cardiac failure:1）［p＝0.013]. Only among the EVAR patients, aortic related death occurred in 1 patient（5.6%), which was acute type A aortic dissection. Conclusion:Endovascular first-line surgical treatment strategy for rAAA is acceptable. However, as the patients with rAAA tended to be unsuitable for EVAR because of anatomical complexity, open abdominal surgery is important even in the endovascular era.

 

Jpn. J. Cardiovasc. Surg. 50:357-362（2021）

Keywords：ruptured abdominal aortic aneurysm;open surgical repair;EVAR;stent graft;indication