P-018 - CLINICAL PRESENTATION, OPERATIVE MANAGEMENT AND LONG-TERM OUTCOME OF RUPTURE FOLLOWING PREVIOUS ABDOMINAL AORTIC ANEURYSM REPAIR

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Sen I. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Kanzafarova I. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Yonkus J. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Mendes B. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Colglazier J. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Shuja F. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Kalra M. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Demartino R. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America) , Rasmussen T. (Mayo Clinic, Rochester, ~ Minnesota ~ United States of America)
Introduction:
The aim of this study was to evaluate presentation trends, intervention and survival of patients treated for late abdominal aortic aneurysm (AAA) rupture (LAR) following open or endovascular aortic aneurysm repair
Methods:
We reviewed the clinical data from a single-center, retrospective database of patients treated for LAR from 2000-2020. Endpoints were 30-day mortality, major post-operative complication, and survival. We compared outcomes between LAR managed with endovascular repair (ER, Group I) versus open repair. (OR, Group II).
Results:
Of 390 patients with infrarenal aortic rupture, 40 (10%) had aortic rupture after a prior aortic repair and comprise the LAR cohort (34 males, age 78 + 8years). LAR followed prior endovascular repair (EVAR) in 30 and prior open repair in 10 patients. LAR after prior OR was secondary to ruptured paraanastomotic pseudoaneurysms. Following intital endovascular repair LAR occurred despite re-intervention in 17 (42%). Time to LAR was shorter following prior EVAR compared to OR (6+ 4 vs. 12+ 4 years respectively, p=0.003). Treatment for LAR was endovascular in 25 patients (63%; Group I) and OR in 15 (37%, Group II). LAR after initial OR was managed with endovascular salvage in 8/10 patients. Endovascular management more frequent in the latter half (Figure1). In Group I, fenestrated repair was used in 7 (28%) patients, salvage in the rest was feasible with EVAR, aortic cuffs or limb extensions. Incidence of free rupture, time to treatment, 30-day mortality and disposition and was similar between groups. Those in Group I had less blood loss (660 vs 3000 mL, p<0.001) and need for dialysis (0% vs 33%, p<0.001) than those in Group II. Median follow up 21 months (IQR 6-45). The 1, 3 and 5-year survival was 76%, 52% and 41%, respectively and similar between groups (28 vs 22 months, p=0.92, Figure 2).
Conclusion:
Late aortic rupture in the years following AAA repair is increasingly common, likely driven by the frequency of EVAR. Most late aortic ruptures, including those following previous open repair, can be now be salvaged with endovascular techniques with lower morbidity and mortality.
ATTACHMENTS: