Last reviewed: June 2018
Last updated: February  2018

Endovascular repair for ruptured AAA has better 3-year survival

Endovascular repair of ruptured abdominal aortic aneurysm (AAA) improves midterm survival compared with an open repair strategy, results from the IMPROVE randomized controlled trial have found.

At 3 years:

  • Mortality was lower among those randomized to endovascular aneurysm repair (EVAR) than to an open repair strategy (48% vs. 56%; hazard ratio [HR] 0.57, 95% CI 0.36 to 0.90)

  • Re-intervention rates did not differ significantly between the randomized groups (HR 1.02, 95% CI 0.79 to 1.32).

Earlier studies, and interim analyses from the IMPROVE trial, had reported comparable short-term survival (≤1 year) between endovascular and open repair strategies in patients with ruptured AAA.

An accompanying editorial stated that the latest IMPROVE trial results ‘...will change clinical practice in favor of endovascular repair for patients with suspected ruptured abdominal aortic aneurysms.’

See Management: approach See Management: treatment algorithm

Original source of update



History and exam

Key diagnostic factors

  • palpable pulsatile abdominal mass

Other diagnostic factors

  • abdominal, back, or groin pain
  • hypotension

Risk factors

  • cigarette smoking
  • hereditary/family history
  • increased age
  • male gender (prevalence)
  • female gender (rupture)
  • congenital/connective tissue disorders
  • hyperlipidemia
  • COPD
  • atherosclerosis (i.e., coronary artery disease [CAD], peripheral arterial occlusive disease)
  • hypertension
  • increased height
  • central obesity
  • nondiabetic

Diagnostic investigations

Investigations to consider

  • CBC
  • blood cultures
  • computed tomography angiography (CTA)/CT
  • magnetic resonance angiography (MRA)/MRI
Full details

Treatment algorithm


Authors VIEW ALL

Professor of Vascular Surgery

Department of Cardiovascular Sciences

University of Leicester, Leicester Royal Infirmary




MJB has grant funding from the British Heart Foundation and the National Institute for Health Research.

Honorary Research Fellow

Department of Cardiovascular Sciences

University of Leicester




AD declares that he has no competing interests.

Professor Matt Bown and Mr Andrew Duncan would like to gratefully acknowledge Dr Maureen K. Sheehan, Dr Dawn M. Barnes, and Dr Gilbert R. Upchurch, previous contributors to this monograph.

Peer reviewers VIEW ALL

Professor of Vascular Surgery

Vascular Surgery Group

Division of Cardiovascular Sciences

Leicester Royal Infirmary



RN declares that he has no competing interests.

Chief of Division of Vascular Surgery

Department of Surgery

Northwestern Memorial Hospital




WP declares that he has no competing interests.

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