Comparative effectiveness of endovascular and surgical repair of ruptured abdominal aneurysm

Background. Abdominal aortic aneurysm rupture is a life threating condition, that requires emergent intervention. At the present stage endovascular aortic repair should be performed, when possible, as a first line strategy, but stent-grafts have some anatomical limitations for use, so surgical repair is still performed in urgent situations.

Aim. To evaluate the results of endovascular and surgical repair of ruptured abdominal aortic aneurysms in vascular center on the base of regional hospital.

Materials and methods. In Krasnoyarsk Regional Clinical Hospital all kinds of aortic interventions are performed, both in acute and stable pathologies. During 5 years 63 patients with acute rupture of abdominal aneurysms where transferred, 31 underwent endovascular repair, 32 – surgical repair. Clinical characteristics, initial state and time for intervention didn’t differ in endovascular and surgical groups.

Results. Technical success was 100% in both endovascular and surgical repair groups. 30-day mortality with endovascular repair was 4 (12.9%) patients, and it was statistically lower compare to surgical repair group – 11 (34%) patients (p = 0.011). Repeat interventions were performed in both groups, without statistical significance in frequency. The superiority of less invasive intervention is seen during 1 year follow up: in endovascular group 1-year survival is 74.2% vs 45.5% in the surgical group (р = 0.039).

Conclusion. In real-life practice endovascular approach demonstrate convincing advantage in 30-day mortality rate in the treatment of patients with abdominal aneurism rupture. The main reason for surgical repair performing in our hospital is the presence of juxta renal aneurysm.