Perioperative Outcomes of Open versus Endovascular Repair for Ruptured Thoracoabdominal Aneurysms

Background: Open aneurysm repair (OAR) remains the gold standard for treating ruptured thoracoabdominal aortic aneurysms (TAAAs). The aim of our study is to compare the 30-day postoperative outcomes among patients with ruptured TAAA undergoing OAR versus endovascular aneurysm repair. Methods: Using the National Surgical Quality Improvement Program database (2006-2015), we identified patients who underwent OAR and endovascular repair for a ruptured TAAA. Postoperative outcomes of interest included mortality, renal failure, stroke, and cardiopulmonary complications. The independent impact of repair type on each of the aforementioned outcomes was examined after robust risk adjustment. Results: A total of 206 ruptured TAAA repairs were performed [OAR 144 (70%) versus endovascular 62 (30%)]. The majority of patients were male (53 %) and white (77%). The comorbidities were similar between the 2 groups. On average, the operative time of OAR was approximately 3 hr longer than endovascular repair (P < 0.001). The mortality was similar between the 2 groups (OAR 38% versus endovascular 26%, P = 0.09). Compared with endovascular repair, OAR was associated with higher rates of renal and pulmonary complications (32% vs. 13%, P = 0.004; 58% vs. 37%, P = 0.007, respectively). After adjusting for high-risk patient characteristics, endovascular repair, in comparison with OAR, was associated with a 66% reduction of pulmonary injury and 70% reduction in renal failure (odds ratio [OR] 0.34, 95% CI 0.16-0.73, P = 0.005; OR 0.30, 95% CI 0.11-0.82, P = 0.02). Conclusions: Our study reflects the contemporary outcomes following the repair of ruptured TAAA. Despite similar mortality, the endovascular approach was associated with a significant reduction in the risk of renal failure and pulmonary injury.