Rupture of Abdominal Aortic Aneurysm in Patients with and without Antecedent Endovascular Repair

BACKGROUND:Reported results of ruptured abdominal aortic aneurysm (rAAA) in patients with antecedent endovascular aneurysm repair (EVAR) to those presenting with de novo rupture show a similar or slightly improved outcome. The aim of this study was to compare differences in the presentation and outcomes of rAAA with and without prior EVAR. METHODS:A retrospective review of 121 patients with rAAA, ruptured identified 2 groups. Group A included 17 patients (rAAA n = 17) with antecedent EVAR and group B consisted of 104 patients (rAAA n = 104) with de novo ruptures, from January 2001 to March 2015 in 3 teaching hospitals. Patient characteristics and perioperative variables were compared; Fisher's exact test was used for categorical variables. For continuous variables, Student's t-test and Mann-Whitney U test were used. RESULTS:Both groups were similar in age, gender, the incidence of hypertension, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, and nicotine abuse. Mean time of presentation from EVAR to rupture in group A was 42 ± 22 months. Mean preoperative transverse or anteroposterior diameter of AAA was 6.6 cm in group A and 7.1 cm in group B. Three patients of 17 (17.6%) in group A were hemodynamically unstable as compared to 47 of 104 patients (45.1%) in group B (P = 0.03). Mean red blood cells, fresh frozen plasma, and platelet transfusion were similar in both groups. Thirty-day mortality was 8 of 17 (44.7%) in group A and 44 of 104 (42.3%) in group B (P = 1.0). Postoperative complications were also similar in both groups except the incidence of postoperative respiratory failure was higher in group B (38%) as compared with 11.1% in group A (P = 0.001). CONCLUSIONS:Patients presenting with rAAA with antecedent EVAR are hemodynamically more stable as compared with patients with de novo rupture of AAA. Postoperative respiratory failure is more common in patients with de novo rupture. rAAA carry high mortality with and without prior EVAR.