The authors of an editorial published in Angiology,1 deemed that a study on the prevention and treatment of ruptured abdominal aortic aneurysms (rAAA) in the same issue2 provides useful information about predictors of perioperative, postoperative, and long-term outcomes in patients undergoing open surgical repair for rAAA.

In the study, factors affecting perioperative, postoperative, and long-term outcomes were examined in 463 patients undergoing open surgical repair for rAAA between 1990 and 2011. The in-hospital mortality rate was 35.6%.

Over the last 20 years, endovascular rAAA repair (rEVAR) has become a better alternative option for the management of rAAAs. Advantages of rEVAR include lower perioperative mortality and morbidity rates, and reduced invasiveness, length of intensive care unit stay, and overall length of hospitalization compared with OSR.

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A survey conducted in 49 centers on outcomes in patients with rAAAs undergoing rEVAR (n=1037) or OSR (n=763) between 2002 and 2006 indicated considerably lower 30-day mortality rates for rEVAR compared with OSR (21.2% vs 36.3%, respectively; P <.0001). A more recent retrospective observational cohort study on the Premier Healthcare Database which included 3164 patients with rAAA managed with rEVAR (n=1614) or OSR (n=1550) from between 2009 and 2015 produced similar results: mortality was 23.79% with rEVAR compared with 36.26% with OSR (adjusted odds ratio: 1.91; 95% CI: 1.62-2.25; P <.001).

Overall, these studies provide real-world evidence of the superiority of rEVAR over OSR as the treatment of choice for rAAAs if certain strategies, techniques, and adjuncts are used. In particular: a standardized approach/protocol; routine use of hypotensive hemostasis/fluid restriction; and performance of the procedure in a site equipped with the necessary fluoroscopic imaging and rEVAR technology.

A limitation of the study is that it identifies predictors of peri- and postoperative outcomes after OSR, not after rEVAR.

“The early detection of AAAs, as well as the identification of predictors for optimal postoperative outcomes following endovascular/open repair of rAAAs, remains crucial topics for the reduction of AAA-related and all-cause mortality,” noted the authors.


  1. Paraskevas KI, Eckstein H, Veith FJ. Prevention and treatment of ruptured abdominal aortic aneurysms (published online May 13, 2020). Angiology.
  2. Barakat HM, Shahin Y, Din W, et al. Perioperative, postoperative,and long-term outcomes following open surgical repair of ruptured abdominal aortic aneurysm. Angiology. 2020:3319720911578. doi:10.1177/0003319720911578 [Epub ahead of print]