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Samer F. Najjar, MD; Kyle H. Mueller, MD; Michael B. Ujiki, MD; Mark D. Morasch, MD; Jon S. Matsumura, MD; Mark K. Eskandari, MD

Arch Surg. 2007;142(11):1049-1052.

Hypothesis  Percutaneous endovascular repair of ruptured abdominal aortic aneurysms (RAAAs) has better outcomes than traditional open surgical repair.

Design  Single-center retrospective review.

Setting  University hospital tertiary referral center.

Patients  Thirty-seven RAAAs treated using endovascular repair (n = 15) or open surgery (n = 22).

Interventions  From January 1, 2000, through December 31, 2005, 15 RAAAs were treated with endovascular stent graft exclusion using commercially available systems. Twenty-two other patients undergoing standard open surgical repair during the same interval comprised a control group for comparison.

Main Outcome Measures  Early outcomes of percutaneous endovascular repair of RAAAs.

Results  Among the endovascular group, the mean ± SD age was 73 ± 9.8 years, 86.6% were men (n = 13), and 20.0% had a preoperative systolic blood pressure of 80 mm Hg or lower (n = 3). An entirely percutaneous procedure was performed in the final 11 patients using arterial closure systems. Technical success of attempted endovascular exclusion was 100.0%. The mean ± SD procedure time (107 ± 30 minutes), transfusion requirements (6.6 ± 4.7 U), and length of stay (3.0 ± 6.8 days) were statistically significantly reduced compared with open surgery. The 30-day mortality was 6.7% (1 of 15) compared with an open surgery 30-day mortality of 13.6% (3 of 22). No late complications (pseudoaneurysm, infection, lymphocele, or neuropathy) occurred after a completely percutaneous technique during a mean follow-up of 12 months.

Conclusion  Percutaneous endovascular repair of RAAAs is a more expedient and less morbid alternative than open surgical repair.

Author Affiliations: Division of Vascular Surgery (Drs Najjar, Morasch, Matsumura, and Eskandari) and Department of Surgery (Drs Mueller, Ujiki, and Eskandari), Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

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Percutaneous Endovascular Repair of Ruptured Abdominal Aortic Aneurysms—Invited Critique
Bruce A. Perler
Arch Surg. 2007;142(11):1053.
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