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:
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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)
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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 algorithmSummary
Definition
Abdominal aortic aneurysm (AAA) is a permanent pathologic dilation of the aorta with a diameter >1.5 times the expected anteroposterior (AP) diameter of that segment, given the patient's gender and body size.
[1]
[2]
The most commonly adopted threshold is a diameter of 3 cm or more.
[3]
More than 90% of aneurysms originate below the renal arteries.
[4]
[Figure caption and citation for the preceding image starts]:
Ultrasound of a 3.8 cm x 4.2 cm AAA
University of Michigan/Dr G.R. Upchurch, Departments of Vascular Surgery and Radiology
[Citation ends].
History and exam
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
- ESR/CRP
- CBC
- blood cultures
- computed tomography angiography (CTA)/CT
- magnetic resonance angiography (MRA)/MRI
Treatment algorithm
Contributors
Authors VIEW ALL
Professor of Vascular Surgery
Department of Cardiovascular Sciences
University of Leicester, Leicester Royal Infirmary
Leicester
UK
Disclosures
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
Leicester
UK
Disclosures
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
UK
Disclosures
RN declares that he has no competing interests.
Chief of Division of Vascular Surgery
Department of Surgery
Northwestern Memorial Hospital
Chicago
IL
Disclosures
WP declares that he has no competing interests.
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