Determining Perioperative Mortality in Patients with Ruptured Abdominal Aortic Aneurysm: Insights from a Retrospective Cohort Study

Tossapol  Prapassaro; Khamin Chinsakchai; Somkiat Techarattanaprasert; Chumpol  Wongwanit; Chanean  Ruansetakit; Kiattisak  Hongku; Suteekhanit  Hahtapornsawan; Nattawut  Puangpunngam; Nuttawut  Sermsathanasawadi; Sasima  Tongsai; Frans ML  Moll; Pramook  Mutirangura

doi:10.33192/smj.v76i8.266315

Authors

Tossapol Prapassaro Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Khamin Chinsakchai Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Somkiat Techarattanaprasert Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Chumpol Wongwanit Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Chanean Ruansetakit Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Kiattisak Hongku Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Suteekhanit Hahtapornsawan Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Nattawut Puangpunngam Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Nuttawut Sermsathanasawadi Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
Sasima Tongsai Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Frans ML Moll Vascular Surgery Department, University Medical Center Utrecht, 3584 Utrecht, The Netherlands
Pramook Mutirangura Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v76i8.266315

Keywords:

Ruptured abdominal aortic aneurysm, perioperative mortality factors

Abstract

Objective: Analyzing factors determining perioperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA) undergoing open surgical repair (OSR) and endovascular aneurysm repair (EVAR).
Materials and Methods: Inclusion of 147 consecutive rAAA patients who underwent OSR (n=37) or EVAR (n=110) between 2000 and 2017. Assessment of patients' demographic data, intraoperative details, and perioperative complications. Investigation of comparative outcomes between OSR and EVAR. Employing logistic regression analysis to identify factors associated with perioperative mortality.
Results: Perioperative mortality rate of 19.04% (28/147), with 8.1% (3/37) for OSR and 22.7% (25/110) for EVAR (p=0.139). Higher prevalence of unfit patients in the non-survived group (82.1% vs. 47.9%, p=0.002). Non-survived group had significantly higher preoperative serum creatinine levels (1.8 ± 1.74 vs. 1.4 ± 5.89, p=0.011). Intraoperatively, non-survived group had higher rates of aortic balloon usage and cardiac arrest (64.3% vs. 22.7% and 28.6% vs. 3.4%, p < 0.001). Multivariable analysis identified age > 80 years old, unfit patient status, aortic balloon usage, postoperative myocardial infarction, postoperative congestive heart failure, and abdominal compartment syndrome as independent predictors of 30-day mortality.
Conclusions: No significant difference in perioperative mortality between OSR and EVAR in rAAA patients. Independent predictors of 30-day mortality include age > 80 years old, unfit patient status, aortic balloon usage, postoperative myocardial infarction, congestive heart failure, and abdominal compartment syndrome. Valuable insights for clinicians in predicting outcomes and improving patient care in rAAA cases.

References

Stather PW, Sidloff D, Dattani N, Choke E, Bown MJ, Sayers RD. Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm. Br J Surg. 2013;100(7):863-72.

Wongwanit C, Mutirangura P, Chierakul N, Chaiyasoot W, Phongraweewan O. Rapidly Enlarging and Asymptomatic Abdominal Aortic Aneurysm in a Male Patient with Chronic Obstructive Pulmonary Disease: A Case Report of Endovascular Aortic Aneurysm Repair (EVAR). Siriraj Med J. 2006;58(5):812-18.

Badger S, Forster R, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev. 2017;5(5):CD005261.

Antoniou GA, Georgiadis GS, Antoniou SA, Pavlidis P, Maras D, Sfyroeras GS, et al. Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair. J Vasc Surg. 2013;58(4):1091-105.

Aziz F. Ruptured abdominal aortic aneurysm: Is endovascular aneurysm repair the answer for everybody? Semin Vasc Surg. 2016;29(1-2):35-40.

de Boer M, Shiraev T, Waller J, Qasabian R. Has EVAR changed the outcomes of ruptured abdominal aortic aneurysms? A decades worth of experience in an Australian Teaching Hospital. ANZ J Surg. 2022;92(4):730-35.

Brown LC, Epstein D, Manca A, Beard JD, Powell JT, Greenhalgh RM. The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress. Eur J Vasc Endovasc Surg. 2004;27(4):372-81.

Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain M, Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190-206.

Menges AL, M DO, Zimmermann A, Dueppers P. Ruptured abdominal aorto-iliac aneurysms: Diagnosis, treatment, abdominal compartment syndrome, and role of simulation-based training. Semin Vasc Surg. 2023;36(2):163-73.

Reimerink JJ, Hoornweg LL, Vahl AC, Wisselink W, Broek T, Legemate DA, et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg. 2013;258(2):248-56.

Desgranges P, Kobeiter H, Katsahian S, Bouffi M, Gouny P, Favre JP, et al. Editor's Choice - ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): A French Randomized Controlled Trial of Endovascular Versus Open Surgical Repair of Ruptured Aorto-iliac Aneurysms. Eur J Vasc Endovasc Surg. 2015;50(3):303-10.

Powell JT, Sweeting MJ, Thompson MM, Ashleigh R, Bell R, Gomes M, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014;348:f7661.

Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010;362(20):1872-80.