During the past 3 decades, there has been a remarkable reduction in the rate of operative mortality among patients undergoing elective AAA repair, and the introduction of endovascular AAA repair (EVAR) may further reduce operative morbidity in this patient population. Unfortunately, a similar improvement in outcome among patients undergoing emergency open repair of RAAAs has not occurred, and operative mortality continues to approach 50% in many leading centers. In light of that, perhaps one of the most impressive observations in the study by Najjar and colleagues from Northwestern University is the remarkably low incidence of operative mortality, 13.6% (3 of 22), among patients undergoing conventional open RAAA repair. Therefore, one must wonder if there is substantial selection bias in the patient population reported in this series, which should be considered in assessing their experience with EVAR among patients with RAAAs. Clearly, all patients with an RAAA were sufficiently hemodynamically stable so that a CT scan could be obtained in each case, which is atypical. Indeed, it is noted that there was a 76-minute delay between obtaining the CT scan and getting the patient to the operating room for surgery. They do not tell us how much time elapsed from the initial examination to getting to the CT scanner or if some of these patients were actually transferred to Northwestern University from other facilities.
Perler BA. Percutaneous Endovascular Repair of Ruptured Abdominal Aortic Aneurysms—Invited Critique. Arch Surg. 2007;142(11):1053. doi:10.1001/archsurg.142.11.1053