Dr. Veith Presents Study Supporting EVAR of Ruptured AAA Over Open Repair

November 18, 2009—At the 36th Annual VEITH Symposium in New York City, the symposium's chairman, Frank J. Veith, MD, presented a study showing that endovascular repair (EVAR) of a ruptured abdominal aortic aneurysm (RAAA) is superior to open aneurysm repair (OAR) in patients with favorable anatomy and in centers that have access to vascular surgeons. The study, “Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms” was recently published by Dr. Veith, et al in the Annals of Surgery (2009;250:818-824).

According to Dr. Veith, “Case and single-center reports have documented the feasibility and suggested the effectiveness of EVAR of RAAAs, but the role and value of such treatment remain controversial.”

The investigators examined a collected experience with the use of EVAR for RAAA treatment from 49 centers. Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible, and included treatment details from a single center and information on 1,037 patients treated by EVAR and 763 patients treated by OAR.

The investigators found that overall 30-day mortality after EVAR in 1,037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean, 49.1%) of their patients and had a 30-day mortality rate of 19.7% (range, 0%–32%) for 680 EVAR patients and 36.3% (range, 8%–53%) for 763 OAR patients (P < .0001). Supraceliac aortic balloon control was obtained in 19.1% ± 12% of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% ± 8.3% of these EVAR patients.

In conclusion, Dr. Veith commented, “There is no doubt that these results indicate that EVAR has a lower procedural mortality at 30 days than OAR in at least some patients and that EVAR is superior to OAR for treating RAAA patients, provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.”