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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2008 Dicembre;15(4):231-9
The role of emergency EVAR in the treatment of ruptured abdominal aortic aneurysms: a review
Nordon I., Hinchliffe R. J., Holt P., J., Morgan R., Loftus I. M., Thompson M. M.
St George’s Vascular Institute London, UK
Elective endovascular repair of aortic aneurysms (EVAR) has short term benefits over open surgery and long term equivalence. The place of EVAR in acute aortic rupture remains less clear. Mortality from aortic rupture continues to be high despite improvements in critical care, and some patients alert at presentation are still denied life-saving procedures on the basis of futility. The feasibility of emergency EVAR (eEVAR) is long established but its place alongside or in place of open surgery lacks evidence. This review examines the current evidence for eEVAR. In these select series mortality from eEVAR is 0-40% compared to matched open operative mortality of 0-54%. Blood transfusion requirement was significantly greater in the open surgical group whilst anatomic eligibility for eEVAR was 41-62%. The majority of evidence is level II or III, with only 7 prospective studies and 1 randomized controlled trial. The exact role for eEVAR in management of aortic rupture remains to be defined. Survival advantage with eEVAR over open surgery has been demonstrated in some studies, but these results should be interpreted with caution due to selection bias.