Factors Predicting 30-Day Mortality in Rupture Abdominal Aortic Aneurysm Treating with Endovascular Aneurysm Repair
Nutsiri Kittitirapong MD*, Nitima Saksobhavivat MD**, Wiwat Tirapanich MD*, Piyanut Pootracool MD*, Suthas Horsirimanont MD*, Sopon Jirasiritham MD*, Surasak Leela-Udomlipi MD*
Affiliation : * Vascular and Transplant Unit, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Endovascular aneurysm repair had become the first line treatment in rupture abdominal aortic aneurysm(rAAA).
Objective : To evaluate factors predicting 30-day mortality in rupture abdominal aortic aneurysm(rAAA) treated with
endovascular abdominal aortic aneurysm repair (rEVAR). Secondary outcome measured the mortality in rEVAR compared
with open surgical repair (rOSR).
Material and Method: The data was retrospectively collected from May 2013-December 2016 in the patients treated with
rEVAR. Stata v.14 (Stata Corp.TX.USA) was used for all statistical analyses.
Results : 44 patients diagnosed with ruptured abdominal aortic aneurysm (rAAA) were included and treated with rEVAR.
Three patients (6%) were suprarenal aortic aneurysm, 11 patients (25%) were diagnosed juxtarenal aortic aneurysm, 2
patients (5%) were thoracoabdominal aortic aneurysm and 28 patients (64%) were infrarenal aortic aneurysm. Hardman
score was more than or equal to 3 in 11 patients (25%). The mean diameter of abdominal aortic aneurysm size was 78 mm.
(+18.13). Twenty-six patients (59%) had hostile neck and 27 patients (61%) were implemented adjunctive procedures.
Fourteen of 44 patients (31.82%) were dead in perioperative period. Using aortic occlusion balloon(AOB) was the only factor
predicting mortality in rEVAR (p = 0.006). The research identified no significant perioperative mortality between rEVAR and
rOSR (31.82% vs. 36.36% p = 0.712). Focusing on the renal outcome, preserving two renal arteries group showed lower
post-operative hemodialysis than preserving one or non-renal artery group (p = 0.022).
Conclusion : Factor predicting 30-day mortality in rEVAR was aortic balloon occlusion. The 30-day mortality between rEVAR
and rOSR was not significantly different. Although hostile neck did not influence the perioperative mortality, it indicated not
only the more adjunctive procedure including chimney and covering renal arteries but also the postoperative hemodialysis.
Keywords : Rupture abdominal aortic aneurysm, Endovascular aneurysm repair, EVAR, Aortic occlusion balloon, Open aneurysmorrhaphy
