New Algorithm For Ruptured Aneurysms Improves Mortality Rate

Main Category: Vascular
Also Included In: Clinical Trials / Drug Trials
Article Date: 12 Jun 2009 - 7:00 PDT

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Researchers from the University of Washington in Seattle report that algorithms for the management of ruptured abdominal aortic aneurysm (rAAA) with a preference for endovascular repair (EVAR), serve as surrogates for an organized approach to managing the disease process and reducing overall mortality. These findings are from a study presented at the 63rd Annual Meeting of the Society for Vascular Surgery®.

"The staff at Harborview Medical Center treat between 30 and 50 patients per year with rAAAs," said Benjamin W. Starnes, MD, chief in the division of vascular surgery and associate professor of surgery at the University of Washington. "In this study we sought to evaluate the effect on mortality with the implementation of an algorithm to manage these patients with a preference for EVAR when feasible."

During the study period, 187 patients with rAAA underwent attempted repair at Harborview Medical Center. Thirty-day mortality ratios were calculated and compared using Chi Square and Fisher's Exact Test where appropriate, continuous variables were compared with a Mann-Whitney U test. Before implementation of the algorithm, (between July 1, 2002 and June 30, 2007) a total of 131 patients with rAAA were managed and treated. One-hundred and twenty-eight underwent surgical treatment and the 30-day mortality rate was 58 percent. Sixty-five percent of these patients were hypotensive at presentation.

A structured protocol that included early proximal control with an aortic occlusion balloon, permissive hypotension and endovascular repair when possible, was begun on July 1, 2007. Fifty-six patients with rAAA were managed and treated. Twenty-six underwent successful EVAR and 25 patients had open repair. Five patients underwent comfort care or died in the emergency department. Five patients in the EVAR group (19 percent) and 14 patients in the open group (56 percent), died during the follow-up period for an overall 30-day mortality rate of 37 percent.

In the post-protocol group, 73 percent of the patients presented with hypotension and there was no difference in the incidence of hypotension between EVAR and open groups. Average transfusion requirement for those undergoing EVAR was one unit (0-13) and for open repair, five units (0-19). The difference in transfusion requirement among survivors in each group was not different.

"Our algorithm reduced rAAA mortality by 36 percent (absolute risk reduction of 25 percent), said Dr. Starnes. "Further reduction in mortality is expected as improvements in endovascular techniques allow treatment of more patients with complex aortic anatomy."

About the Society for Vascular Surgery®

The Society for Vascular Surgery (SVS) is a not-for-profit society that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 2,800 vascular surgeons dedicated to the prevention and cure of vascular disease.

Source: Society for Vascular Surgery