Endovascular repair of ruptured abdominal aortic aneurysms

Abstract

Ruptured abdominal aortic aneurysms (RAAA) are associated with significant morbidity and mortality. Despite significant medical advances in the last few decades, the mortality from traditional open repair approaches 50%. Since the mid 1990's, endovascular repair (EVAR) has been widely adopted for management of elective abdominal aortic aneurysms. EVAR has been increasingly reported by multiple centers for RAAA. Widespread application of EVAR in this setting, however, has been limited due to multiple factors including lack of feasibility, logistic issues, and a paucity of clear evidence. This article examines the body of existing literature on this topic. High-level evidence supporting the use of EVAR for RAAA is lacking. At present, the limited available evidence suggests some advantages for the use of EVAR compared to OR regarding immediate survival. Nevertheless, the data available are still largely inadequate to recommend widespread adoption of EVAR for RAAA. Further research to refine the indications for EVAR by enrolling RAAA patients in large multicenter randomized clinical trials is advisable.