(IPC02) Ten-year experience with an endovascular treatment protocol for ruptured abdominal aortic aneurysm

Objectives: To report a ten-year experience of a major center in the treatment of ruptured abdominal aortic aneurysm (RAAA) following the implementation of a comprehensive protocol.

Methods: Retrospective analysis of consecutive RAAA patients treated from January 2011 to December 2023, after implementation of protocol-based care. The variables of interest were hemodynamic stability, proximal neck length and type of intervention. The outcomes were 30-day mortality and long-term survival. Statistical analyses were conducted using the chi-square test, Student's t-test, and Pearson correlation. Logistic regression was used to construct a propensity score for matching, and survival rates were illustrated using Kaplan-Meier curves.

Results: Among 209 treated patients (81.8% male, average age 69 years, average diameter at rupture 82 mm), anatomical location included infra-renal, isolated iliac, and juxta-renal aneurysms. Endovascular repair was performed in 121 patients (57.9%), with a significant difference in proximal neck length compared to the open repair group (median 19.7 mm vs. 7.9 mm, P < .001). Hemodynamic instability was present in 39% at admission. The overall 30-day mortality rate was 44%; endovascular repair was associated with lower mortality (34.7%, P = .001). Factors such as kidney failure, hemodynamic stability, proximal neck length, and morphology were significantly associated with mortality outcomes. However, propensity score matching (42 pairs) revealed no statistical superiority of either technique.

Conclusions: Despite broad consensus within the medical community regarding the superiority of endovascular repair for ruptured abdominal aortic aneurysms, this study did not detect any significant differences in 30-day or long-term mortality between endovascular techniques and open repair when anatomically feasible. Intervention choices should be tailored based on individual anatomical circumstances, the expertise of the medical team, and the resources at hand. Our propensity score analysis was the first to consider anatomical features; nevertheless, endovascular repair demonstrated no clear superiority to open repair.