Endovascular Versus Open Repair for Ruptured Complex Abdominal Aortic Aneurysms: A Propensity Weighted Analysis

This study evaluates 30-day mortality after endovascular aneurysm repair (EVAR) versus open repair for ruptured complex abdominal aortic aneurysms (cAAAs), including juxtarenal, pararenal, suprarenal, and extent IV thoracoabdominal aortic aneurysms (TAAA) in a real-world setting. The Targeted Vascular Module from the American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients undergoing repair for ruptured cAAA from 2011 to 2017. Primary endpoint was 30-day mortality. Secondary endpoints included renal failure, pulmonary complications, ischemic colitis, cardiac complications, lower extremity ischemia, post-operative rupture, and intensive care unit (ICU) length of stay (LOS). EVAR and open repair were compared using inverse probability weights. Four hundred forty-six patients had a ruptured cAAA repair during the study years; 105 (23.7%) were repaired via EVAR and 338 (76.3%) received open repair. The distribution by aneurysm type was as follows: 253 juxtarenal (57.1%), 59 pararenal (13.3%), and 100 suprarenal (22.6%) AAA with 31 type IV TAAA (7.0%). Juxtarenal aneurysms were more likely to be performed open than EVAR (P