Endovascular Repair of Ruptured Abdominal Aortic Aneurysms in a Rural Center Is Both Feasible and Associated with Reduced Blood Product Requirements

Abstract

Endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has been shown to be both feasible and associated with a reduced operative mortality when compared with conventional open repair (OR). The aim of this study was to show the feasibility of EVAR of rAAA in a rural vascular unit and to investigate the blood product requirements when compared to OR. The method used in this study was a retrospective case note review of patients presenting with rAAA to a small, rural vascular unit between February 2004 and November 2008. Admission demographics and hematological variables were recorded. Volumes of crystalloid, colloid and blood products were recorded prior to intensive care unit (ICU) admission and for the first 48 hours following ICU admission. Results are expressed as medians and Mann-Whitney U test was used to compare variables. Of 81 patients presenting with rAAA, 36 were treated palliatively. Of 45 patients who underwent intervention, 7 had EVAR and all survived to discharge (0% operative mortality). Of 38 who had OR, 16 died before discharge for an operative mortality of 42%, 36% if the EVAR patients are included. Admission demographics and hematological variables of patients who had EVAR, patients who had OR and survived (ORS) and patients who had OR and died (ORD) showed no significant difference. When compared with ORS patients, those undergoing EVAR had significantly less pre-ICU crystalloid (3 L vs 7.5 L, p = .001), less red blood cell transfusion (1 unit vs 6.5 units, p = .0006), and less colloid (0 L vs 0.5 L, p = .008). When compared with ORD, those undergoing EVAR had less red blood cell transfusion (1 unit vs 7 units, p = .0001) and less fresh frozen plasma (0 units vs 4 units, p = .03). Within the first 48 hours of admission to ICU, the blood product requirements were no different in those undergoing EVAR when compared with OR. EVAR of rAAA is feasible in a small rural vascular unit and appears to be associated with reduced requirements for blood products.