Use of Aortic Occlusion Balloon After EVAR in Ruptured AAA Studied

December 15, 2015—Results of a meta-analysis and metaregression analysis of the impact on mortality of aortic occlusion balloon (AOB) treatment after endovascular repair of ruptured abdominal aortic aneurysms (RAAA) were published by Christos D. Karkos, MD, et al in CardioVascular and Interventional Radiology (2015;38:1425–1437).

The investigators concluded that this study provides meta-analytical evidence that the use of an AOB in unstable RAAA patients undergoing endovascular repair may improve the results.

As summarized in CardioVascular and Interventional Radiology, the investigators conducted a meta-analysis of the English-language literature through February 2013. Articles reporting data on outcome after endovascular repair of RAAAs were identified and information regarding the use of AOB was sought. The meta-analysis included 39 eligible studies reporting 1,277 patients.

The pooled perioperative mortality was 21.6% (95% confidence interval, 18.1%–25.1%). There was significant within-study heterogeneity (I² = 50.2%; P < .001). A total of 200 patients required AOB with an estimated pooled proportion of 14.1% (8.9%–19.3%).

The investigators found that individual random-effects metaregression investigating the effect of AOB and other risk factors on mortality revealed a significant linear association of hemodynamic instability, bifurcated endograft approach, and primary conversion to open repair with mortality and a nonlinear (second degree polynomial) association of AOB with mortality.

On multivariable metaregression models, both hemodynamic instability and AOB were found to be statistically significant, independent predictors of mortality. In particular, there was a statistically significant negative correlation between AOB and mortality and a positive effect of hemodynamic instability on mortality.

In practical terms, mortality was significantly higher in studies with a higher proportion of hemodynamically unstable patients and lower in studies with a higher rate of AOB use, reported the investigators in CardioVascular and Interventional Radiology.