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01-05-2016 | REVIEW ARTICLE

Current treatment strategies for ruptured abdominal aortic aneurysm

Authors: Andreas S. Peters, Maani Hakimi, Philipp Erhart, Michael Keese, Thomas Schmitz-Rixen, Markus Wortmann, Moritz S. Bischoff, Dittmar Böckler

Published in: Langenbeck's Archives of Surgery | Issue 3/2016

Abstract

Background

Ruptured abdominal aortic aneurysm (rAAA) represents one of the most challenging emergencies in surgery. Open repair (OR) is associated with relevant morbidity and mortality and has not been reduced significantly over the last decade. The introduction of endovascular aneurysm repair (EVAR) and its meanwhile common use in the treatment of rAAA has raised the demand for randomised controlled trials (RCTs) in order to resolve a potential superiority of either OR or EVAR.

Purpose

This review discusses the current treatment strategies in rAAA repair including diagnostics, peri-operative management and results of OR and EVAR, focussing on RCTs comparing both modalities.

Results

Thirty-day mortality after OR and EVAR shows no significant difference in published RCTs. In particular with respect to OR, 30-day mortality was much lower than anticipated throughout all RCTs ranging from 18 to 37 %. EVAR for rAAA resulted in reduced in-hospital stay. Limitations of all except one RCT are low patient recruitment and exclusion of haemodynamically unstable patients.

Conclusions

OR and EVAR need to be provided for rAAA. Despite lacking evidence, EVAR is the first choice treatment in experienced high-volume vascular centres. Low mortality rates in all RCTs raise the question if aortic surgery should be centralised.

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Title: Current treatment strategies for ruptured abdominal aortic aneurysm
Authors: Andreas S. Peters
Maani Hakimi
Philipp Erhart
Michael Keese
Thomas Schmitz-Rixen
Markus Wortmann
Moritz S. Bischoff
Dittmar Böckler
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 3/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1405-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Current treatment strategies for ruptured abdominal aortic aneurysm

Abstract

Background

Purpose

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Purpose

Results

Conclusions

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