Has the implementation of EVAR for ruptured AAA improved outcomes?

OBJECTIVE: Previous studies have demonstrated improved outcomes with endovascular aneurysm repair (EVAR) for the treatment of ruptured abdominal aortic aneurysms (rAAA). However, these data may not be generalizable to all regions. METHODS: Retrospective cohort study (2001-2005) using state inpatient data. RESULTS: 5,176 patients underwent repair of AAA. 700 repairs were performed for rAAA (618 [88%] with open surgery (OS) and 82 [12%] with EVAR). Mortality for rAAA was similar for EVAR and OS (45.1% vs. 52.4%, P = 0.21). Lack of insurance (OR = 5.1; 95%CI: 1.7-15.2) was a predictor of mortality. Cost of repair for rAAA was greater for EVAR ($51,339 +/- 51,719 vs. $39,967 +/- 43,354, P = 0.03) and hospital LOS was similar (14.08 +/- 17.97 vs.13.42 +/- 18.18; P = 0.8). CONCLUSION: EVAR did not offer a survival benefit in the state, had a similar hospital LOS, and was significantly more expensive. Further evaluation exploring explanations for inferior outcomes by region are required as EVAR becomes more commonly implemented for rAAA.