Efficacy and safety of endovascular repair versus open surgery for ruptured abdominal aortic aneurysm: a comparative study.

Abstract

Objective: Ruptured abdominal aortic aneurysm (rAAA) is a life-threatening condition with high mortality. This study compared the efficacy and safety of open surgical repair (OSR) and endovascular aortic repair (EVAR) in the treatment of rAAA.

Methods: A retrospective analysis of clinical data was conducted for 232 rAAA patients treated at Taizhou Central Hospital and the First Affiliated Hospital of Wenzhou Medical College. Patients were divided into two groups based on surgical methods: OSR group (n=84) and EVAR group (n=148). Perioperative indicators, perioperative complication rates, and 1-year mortality rates were compared. Patients were further divided into a survival group (n=160) and a death group (n=72) based on their 1-year survival status, and the risk factors affecting the prognosis of rAAA patients were analyzed. Postoperative pain was evaluated using the Visual Analog Scale (VAS), Verbal Rating Scale (VRS), and Present Pain Intensity (PPI). Serum levels of C-reactive protein (CRP) and white blood cells (WBC), pro-inflammatory interleukins (IL-1α, IL-6, IL-8), and tumor necrosis factor-α (TNF-α) were measured before and after treatment using enzyme-linked immunosorbent assays (ELISA).

Results: Compared with the OSR group, the EVAR group had significantly shorter surgical time, less intraoperative bleeding (IOB) and intraoperative blood transfusion volume, reduced intraoperative infusion volume, shorter fasting and first walk time, and shorter ICU and hospital days. The incidence of complications in the EVAR group was significantly lower than that in the OSR group (P<0.05). Pain scores (VAS, VRS, and PPI) and serum levels of CRP, WBC, IL-1α, IL-6, IL-8, and TNF-α were significantly lower in the EVAR group than those in the OSR group (all P<0.05). There was no significant difference in perioperative mortality between the two groups (28.95% vs. 11.80%, P>0.05). However, the 1-year mortality rate was significantly lower in the EVAR group (38.1% vs. 27.0%, P<0.05). Multivariate logistic regression analysis identified Alb<40 g/L (P=0.004), Cre≥1.5 mg/dL (P=0.007), urea nitrogen ≥25 mg/dL (P=0.001), ALT≥40 U/L (P=0.002), and treatment method (OSR) (P=0.024) as independent risk factors for poor postoperative prognosis.

Conclusion: EVAR demonstrates significant advantages over OSR in reducing surgical trauma, decreasing postoperative complications, alleviating pain and inflammatory responses, and improving postoperative survival rates.