Dottorato in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO-VASCOLARE

Titolo della tesi: RUPTURED ABDOMINAL AORTIC ANEURYSMS: OPEN AND EVAR SURGICAL TREATMENT. INDICATIONS AND RESULTS.

Objective: Despite the advances in surgical and anaesthesiologic management, ruptured abdominal aortic aneurysms (rAAAs) still represents a challenge for vascular surgeon, because of high morbidity and mortality rate. Endovascular aortic repair (EVAR) is considered a valid therapeutic option over open surgical repair (OSR) but its use is still debated in emergency setting. Our aim is to analyse early and mid-term outcomes related to EVAR versus OSR treatment in patients with rAAA. Methods: We analysed data from medical records regarding 138 consecutive patients with rAAA who underwent OSR or EVAR between 2006-2019. Outcomes included early and mid-term mortality, early and mid-term postoperative complications, re-intervention rate and length of hospital stay. Results: rAAA-related mortality rate was significantly higher in OSR group vs EVAR group: 17,89% vs 4,65% (P=0,0365) at 24 hours respectively, 36,84% vs 16,28% (P=0,0150) at 30 days respectively. No difference was observed at one year between two groups (P=0,4283). EVAR group had a higher rAAA-related complications and re-interventions rate but patients were discharged at home faster and more often compared with OSR group. Conclusion: Our study shows that one-year mortality was not reduced in the EVAR cohort, likely due to the preoperative hemodynamic instability, which has a negative impact on the patient's outcome, regardless of the intervention strategy. Further studies are needed in order to establish a standardised protocol for the most appropriate management of rAAA. The evaluation of a long-term follow-up could help in defining with certainty the superiority of the endovascular approach over traditional surgery.