Impact of internal iliac interventions on mortality and intestinal ischemia in ruptured abdominal aortic aneurysm endovascular repair

Abstract

Objectives

Ruptured abdominal aortic aneurysm (RAAA) is a life-threatening vascular emergency with high mortality rate despite advances in surgical and endovascular techniques. This study evaluates the impact of internal iliac artery interventions on short-term (30-day) and long-term (up to 6564 days) mortality and intestinal ischemia in patients undergoing endovascular aneurysm repair (EVAR) for RAAA.

Methods

A retrospective analysis of 4274 patients who underwent emergent EVAR for RAAA between 2004 and 2022 was conducted using the Vascular Quality Initiative (VQI) database. Patients were stratified into four groups based on the type of internal iliac intervention: no intervention, revascularization of at least one internal iliac artery, occlusion of both internal iliac arteries, and occlusion of one internal iliac artery. Mortality and intestinal ischemic outcomes were compared using chi-square tests, and logistic regression models were used to identify significant predictors.

Results

No statistically significant differences in short-term (p = .5638) or long-term mortality (p = .5776) were observed between groups. Group 3 (occlusion of both internal iliac arteries) had the highest rates of intestinal ischemia (11.36%) and 30-day mortality (31.11%), though these differences were not statistically significant. Intestinal ischemia increased the odds of long-term mortality by 2.82 times (p < .001). Advanced age and preoperative creatinine levels were strong predictors of mortality: each additional year of age increased the odds of death by 7% (p < .0001), and the presence of COPD raised the odds of long-term mortality by 51% (p < .001). Prolonged procedure time and blood loss were also associated with higher risks of both long-term mortality and intestinal ischemia.

Conclusions

The type of internal iliac intervention did not significantly affect short-term or long-term mortality, but mitigating intraoperative factors such as prolonged procedure time and excessive blood loss is critical for improving short-term survival and reducing the risk of intestinal ischemia. Managing chronic conditions like COPD and optimizing renal function are essential to improving long-term outcomes, especially in high-risk patients with advanced age and systemic disease.

Keywords

Ruptured abdominal aortic aneurysm (RAAA)endovascular aneurysm repair (EVAR)internal iliac artery intervention intestinal ischemia short-term and long-term mortality

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