Abstract
Introduction: Abdominal aneurysm is considered a formidable pathological condition that requires prompt treatment. Its progressive increase leads to rupture and massive internal bleeding, which requires the most effective medical care. However, despite the improvement in medical equipment and postoperative care, mortality due to ruptured abdominal aneurysms is still close to 50%, which is primarily related to the severity of the pathology and open surgical intervention.
Materials and Methods: 46 patients diagnosed with rupture of the abdominal aorta took part in the study. Selection criteria were a history of abdominal aortic rupture, conservative/operative treatment for the disease, and absence of other complications (acute renal failure, liver infarction) that could affect the results of the study.
Results: Since January 2018, 46 cases of ruptured AAAs have been diagnosed. In all forty-six cases, surgical intervention was used: open surgery or endovascular technique. All 100% of patients had a previous history of diagnosed abdominal aortic aneurysm, for which they underwent periodic ultrasound examinations.
As a result of the study, it was found that endovascular aortic aneurysm correction is the optimal method for both planned and emergency treatment of aortic aneurysm and its rupture. According to the Cochrane Specialized Register, it was established that endovascular repair is associated with a reduction in early morbidity and mortality after abdominal aneurysm, compared with other methods of surgical treatment. Furthermore, the study found that, unlike open surgery methods, endovascular techniques are associated with a lower risk of complications in the form of intestinal ischemia.
Conclusions: Inferior quality studies and lack of information limit the conclusions of this review. From the statistical data shown in this paper, it can be concluded that there is a difference between endovascular and open methods of treatment of abdominal aortic aneurysm rupture. Mortality within the first 30 days after treatment and short-term complications are significantly lower in patients using EVAR. Systemic complications are also more prevalent in patients who were prescribed open surgical treatment.
References
Loban, M., Gratama, J. W. C., Klemm, P. L., Van Leeuwen, R. B., Vriesema, H., Bienfait, H. P. 2023. High prevalence of abdominal aortic aneurysm in older men with cerebrovascular disease: Evaluation of a local screening program. Frontiers in Neurology, 14, 1131322.
Thompson, S. G., Bown, M. J., Glover, M. J., Jones, E., Masconi, K. L., Michaels, J. A., Powell, J. T., Ulug, P., & Sweeting, M. J. (2018). Screening women aged 65 years or over for abdominal aortic aneurysm: A modeling study and health economic evaluation. Health Technology Assessment, 22(43). https://doi.org/10.3310/hta22430
Jacomelli, J., Summers, L., Stevenson, A., Lees, T., Earnshaw, J. J. (2016). Impact of the first 5 years of a national abdominal aortic aneurysm screening program. British Journal of Surgery, 103(9), 1125–1131.
Thorbjørnsen, K., Svensjö, S., Djavani Gidlund, K., Gilgen, N. P., Wanhainen, A. 2019. Prevalence and natural history of and risk factors for subaneurysmal aorta among 65-year-old men. Upsala Journal of Medical Sciences, 124(3), 180-186.
Nordon, I. M., Hinchliffe, R. J., Loftus, I. M., Thompson, M. M. (2011). Pathophysiology and epidemiology of abdominal aortic aneurysms. Nature Reviews Cardiology, 8(2), 92–102.
Moll, F. L., Powell, J. T., Fraedrich, G., Verzini, F., Haulon, S., Waltham, M., van Herwaarden, J. A., Holt, P. J., van Keulen, J. W., Rantner, B., Schlösser, F. J., Setacci, F., Ricco, J. B., European Society for Vascular Surgery. 2011. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. European Journal of Vascular and Endovascular Surgery, 41(Suppl 1), S1-S58.
Gibbons, R. C., Singh, G., Donuru, A., Young, M. (2023). Abdominal aortic aneurysm imaging. Tampa: StatPearls.
Reite, A., Søreide, K., Kvaløy, J. T., Vetrhus, M. 2020. Long-term outcomes after open repair for ruptured abdominal aortic aneurysm. World Journal of Surgery, 44(6), 2020-2027.
Robertson, L., Nandhra, S. (2017). Laparoscopic surgery for elective abdominal aortic aneurysm repair. Cochrane Database of Systematic Reviews, p. 5, CD012302.
Tchana-Sato, V., Sakalihasan, N., Defraigne, J. O. 2018. Ruptured abdominal aortic aneurysm. Revue Médicale de Liège, 73(5-6), 296-299.
Daye, D., Walker, T. G. (2018). Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: Evaluation and management. Cardiovascular Diagnosis and Therapy, 8(Suppl 1), S138-S156.
Gorham, T. J., Taylor, J., Raptis, S. (2004). Endovascular treatment of abdominal aortic aneurysm. British Journal of Surgery, 91(7), 815–827.
Greenhalgh, R. M., Forbes, J. F., Fowkes, F. G., Powel, J. T., Ruckley, C. V., Brady, A. R., Brown, L. C., Thompson, S. G. (1998). Early elective open surgical repair of small abdominal aortic aneurysms is not recommended: Results of the UK Small Aneurysm Trial. Steering Committee. European Journal of Vascular and Endovascular Surgery, 16(6), 462–464.
Veith, F. J., Ohki, T., Lipsitz, E. C., Suggs, W. D., Cynamon, J. (2003). Treatment of ruptured abdominal aneurysms with stent grafts: A new gold standard? Seminars in Vascular Surgery, 16(2), 171–175.
Parodi, J. C., Palmaz, J. C., Barone, H. D. 1991. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Annals of Vascular Surgery, 5(6), 491-499.
Harris, P., Buth, J., EUROSTAR, Beard, J., RETA. (2005). What is the future for registries on endovascular aortic aneurysm repair, and who should be responsible? European Journal of Vascular and Endovascular Surgery, 30(4), 343–345.
Mani, K., Lees, T., Beiles, B., Jensen, L. P., Venermo, M., Simo, G., Palombo, D., Halbakken, E., Troëng, T., Wigger, P., Björck, M. 2011. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: A vascunet report. European Journal of Vascular and Endovascular surgery, 42(5), 598-607.
Paravastu, S. C. V., Jayarajasingam, R., Cottam, R., Palfreyman, S. J., Michaels, J. A., Thomas, S. M. (2014). Endovascular repair of abdominal aortic aneurysm. Cochrane Database of Systematic Reviews, 1, CD004178.
Badger, S., Forster, R., Blair, P. H., Ellis, P., Kee, F., Harkin, D. W. (2017). Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database of Systematic Reviews, p. 5, CD005261.
Greenhalgh, R. M., EVAR trial participants. 2004. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: Randomised controlled trial. The Lancet, 364(9437), 843–848.
EVAR trial participants. 2005. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): Randomised controlled trial. The Lancet, 365(9478), 2179-2186.
Patel, R., Powell, J. T., Sweeting, M. J., Epstein, D. M., Barrett, J. K., Greenhalgh, R. M. (2018). The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: Long-term follow-up and cost-effectiveness analysis. Health Technology Assessment, 22(5). https://doi.org/10.3310/hta22050
EVAR trial participants. 2005. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): Randomised controlled trial. The Lancet, 365(9478), 2187-2192.
Debus, E. S. (2018). S3 guideline on screening, diagnosis, treatment, and aftercare of abdominal aortic aneurysm. Gefässchirurgie, 23(6), 402-403.
Siika, A., Bogdanovic, M., Liljeqvist, M. L., Gasser, T. C., Hultgren, R., Roy, J. 2023. Three-dimensional growth and biomechanical risk progression of abdominal aortic aneurysms under serial computed tomography assessment. Scientific Reports, 13(1), 9283.
Grima, M. J., Boufi, M., Law, M., Jackson, D., Stenson, K., Patterson, B., Loftus, I., Thompson, M., Karthikesalingam, A., Holt, P. (2018). Editor’s choice – The implications of non-compliance to endovascular aneurysm repair surveillance: A systematic review and meta-analysis. European Journal of Vascular and Endovascular Surgery, 55(4), 492–502.
Grootes, I., Barrett, J. K., Ulug, P., Rohlffs, F., Laukontaus, S. J., Tulamo, R., Venermo, M., Greenhalgh, R. M., Sweeting, M. J. 2018. Predicting risk of rupture and rupture-preventing reinterventions following endovascular abdominal aortic aneurysm repair. British Journal of Surgery, 105(10), 1294-1304.
Ettengruber, A., Epple, J., Schmitz-Rixen, T., Böckler, D., Grundmann, R. T., DIGG gGmbH. 2022. Long-term outcome and cancer incidence after abdominal aortic aneurysm repair. Langenbeck’s Archives of Surgery, 407(8), 3691-3699.
Schmitz-Rixen, T., Böckler, D., Vogl, T. J., Grundmann, R. T. 2020. Endovascular and open repair of abdominal aortic aneurysm. Deutsches Arzteblatt International, 117(48), 813-819.
Chaikof, E. L., Dalman, R. L., Eskandari, M. K., Jackson, B. M., Lee, W. A., Mansour, M. A., Mastracci, T. M., Mell, M., Murad, M. H., Nguyen, L. L., Oderich, G. S., Patel, M. S., Schermerhorn, M. L., Starnes, B. W. 2018. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery, 67(1), 2-77.e2.
Wanhainen, A., Verzini, F., Van Herzeele, I., Allaire, E., Bown, M., Cohnert, T., Dick, F., van Herwaarden, J., Karkos, C., Koelemay, M., Kölbel, T., Loftus, I., Mani, K., Melissano, G., Powell, J., Szeberin, Z., Esvs Guidelines Committee, de Borst, G. J., Chakfe, N., Debus, S., Hinchliffe, R., Kakkos, S., Koncar, I., Kolh, P., Lindholt, J. S., de Vega, M., Vermassen, F., Document Reviewers, Björck, M., Cheng, S., Dalman, R., Davidovic, L., Donas, K., Earnshaw, J., Eckstein, H. H., Golledge, J., Haulon, S., Mastracci, T., Naylor, R., Riccom J. B., Verhagen, H. 2019. Editor’s choice – European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. European Journal of Vascular and Endovascular Surgery, 57(1), 8-93.
Kontopodis, N., Galanakis, N., Antoniou, S. A., Tsetis, D., Ioannou, C. V., Veith, F. J., Powell, J. T., Antoniou, G. A. (2020). Meta-analysis and meta-regression analysis of outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm. European Journal of Vascular and Endovascular Surgery, 59(3), 399–410.
Varkevisser, R. R. B., Swerdlow, N. J., de Guerre, L. E. V. M., Dansey, K., Stangenberg, L., Giles, K. A., Verhagen, H. J. M., Schermerhorn, M. L., Society for Vascular Surgery Vascular Quality Initiative. 2020. Five-year survival following endovascular repair of ruptured abdominal aortic aneurysms is improving—Journal of Vascular Surgery, 72(1), 105-113.e4.
Visser, J. J., van Sambeek, M. R. H. M., Hamza, T. H., Hunink, M. G. M., Bosch, J. L. 2007. Ruptured abdominal aortic aneurysms: Endovascular repair versus open surgery – Systematic review. Radiology, 245(1), 122-129.
Luebke, T., Brunkwall, J. 2015. Risk-adjusted meta-analysis of 30-day mortality of endovascular versus open repair for ruptured abdominal aortic aneurysms. Annals of Vascular Surgery, 29(4), 845-863.
Visser, J. J., Bosch, J. L., Hunink, M. G. M., van Dijk, L. C., Hendriks, J. M., Poldermans, D., van Sambeek, M. R. H. M. 2006. Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: Clinical outcomes with 1-year follow-up. Journal of Vascular Surgery, 44(6), 1148-1155.
Takagi, H., Umemoto, T. 2011. A meta-analysis of randomized and risk-adjusted observational studies of endovascular versus open repair for ruptured abdominal aortic aneurysm. Vascular and Endovascular Surgery, 45(8), 717-719.
Qin, C., Chen, L., Xiao, Y. B. (2014). Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: A meta-analysis. PLoS One, 9(1), e87465.
van Beek, S. C., Conijn, A. P., Koelemay, M. J., Balm, R. 2014. Editor’s choice – Endovascular aneurysm repair versus open repair for patients with a ruptured abdominal aortic aneurysm: A systematic review and meta-analysis of short-term survival. European Journal of Vascular and Endovascular Surgery, 47(6), 593-602.
Antoniou, G. A., Georgiadis, G. S., Antoniou, S. A., Pavlidis, P., Maras, D., Sfyroeras, G. S., Georgakarakos, E. I., Lazarides, M. K. (2013). Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair. Journal of Vascular Surgery, 58(4), 1091–1105.
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