Impact of Preoperative Image Sharing and Anatomical Suitability on EVAR Outcomes for Ruptured Abdominal Aortic Aneurysm.

Abstract

Objectives: The influence of anatomical suitability on outcomes after endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) remains uncertain. This study evaluated the association between adherence to device instructions for use (IFU) and clinical outcomes after EVAR for rAAA.

Methods: We retrospectively reviewed 31 consecutive patients who underwent emergency EVAR for rAAA between August 2016 and June 2023. Anatomical suitability was assessed by retrospective computed tomography, and patients were classified as inside or outside IFU. The influence of preoperative image sharing (JOIN; Allm, Tokyo, Japan) on perioperative workflow was also evaluated, with patients divided into image-sharing and non-image-sharing groups. The primary outcome was reintervention; secondary outcomes included 30-day and overall mortality.

Results: Twenty patients (64.5%) were inside IFU and eleven (35.5%) were outside IFU. Outside-IFU cases had shorter proximal neck length and greater neck angulation. Reintervention was more frequent outside IFU than inside IFU (63.6% vs. 10.0%, p <0.01), whereas 30-day mortality (18.2% vs. 10.0%, p = 0.601) and overall mortality (36.4% vs. 60.0%, p = 0.300) were not significantly different. Prehospital image sharing using the JOIN application was associated with shorter door-to-operating room time despite longer transfer distance.

Conclusions: EVAR for rAAA may achieve acceptable early survival in selected outside-IFU cases; however, outside-IFU anatomy is associated with increased reintervention. Careful patient-specific selection and structured follow-up are essential.