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Invited Critique
August 14, 2009

Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms—Invited Critique

Arch Surg. 2009;144(8):778-779. doi:10.1001/archsurg.2009.133

I only run for fire and hemorrhage. Gershon Efron, MD, circa 1996

Aruptured abdominal aortic aneurysm demands immediate diagnosis and a skilled team to deliver operative care in an expedient and effective manner. General refinement in aortic surgery to address aneurysmal disease has greatly improved contemporary results for elective repair, yet similar reductions in the morbidity and mortality rate after open repair of RAAAs have stalled in the range of 40% to 50% for decades. The advent of endovascular aneurysm repair (EVAR) created a new treatment paradigm for eventual expansion into the arena of RAAA. It is no surprise that surgeons who were frustrated by experiences with RAAAs have recognized the many benefits of EVAR to address this life-threatening condition. Karkos and colleagues have provided us with a sound meta-analysis of 29 publications reviewing 897 patients with RAAAs, thus offering us a window to see the true state of the art of endovascular repair of RAAAs. The finding of 25% mortality with EVAR for RAAAs is a great advance in benefitting our patients over the comparative open surgical mortality values.