Is less really more? The answer appears complicated in the case of ruptured abdominal aortic aneurysms (rAAAs). Over the last 40 years, the mortality rate among patients who underwent surgical repair for this ominous disease has remained at 40% to 50%,1 a staggering figure given advances in diagnosis, surgical technique, and perioperative care. Moreover, patients who survive the operation often die of multiorgan failure and late death in the intensive care unit. Given the success of endovascular aneurysm repair (EVAR) for nonruptured aneurysms,2 it seems logical that a less invasive approach to ruptures would improve survival and reduce the number of complications that are often associated with major open repairs. Surprisingly, however, a number of randomized European trials, most notably the IMPROVE (Immediate Management of Patients With Rupture: Open versus Endovascular Repair) trial,3 have demonstrated that the nonselective use of EVAR for rAAAs does not yield a survival advantage.
Benharash P, Toppen W. Bundles of Care for Patients With Ruptured Abdominal Aortic AneurysmsIs Endovascular Repair the Solution?. JAMA Surg. 2015;150(11):1065. doi:10.1001/jamasurg.2015.1872