Existing Delays Following the Presentation of Ruptured Abdominal Aortic Aneurysm Allow Sufficient Time to Assess Patients for Endovascular Repair

The greatest benefit of endovascular AAA repair (EVAR) may be in the management of rupture (RAAA). However, the detailed anatomical assessment required for EVAR has lead to concerns of surgical delay and death during cross-sectional imaging. In this study, we prospectively assessed patients with RAAA and correlated time of hospital arrival with time of surgery or death to ascertain whether these concerns are justified. All patients presenting with RAAA between October 2000 and December 2002 were included. The hospital arrival time, onset of surgery or time of death, were recorded, as were demographic and physiological parameters. One hundred consecutive patients were studied, median age 75 years (range 54–94). Seventy-nine patients underwent attempted conventional surgical repair and 21 were palliated. The median delay from arrival to operation was 159 min (range 16–1450 min). Mortality in the surgical group was not affected by the length of delay ( p=1.0) or by CT scanning ( p=0.34). The median time from arrival to death in the non-surgical group was 435 min (15 min–6 days). Most patients who present with ruptured AAA experience a significant delay prior to surgery. This study suggests it is safe to assess the majority of RAAA patients for EVAR.