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SVS: Protocol for Ruptured Aneurysms Improves Survival

Algorithm with preference for endovascular repair reduces mortality by 40 percent at hospital

FRIDAY, June 12 (HealthDay News) -- An algorithm with a preference for endovascular repair to manage patients with ruptured abdominal aortic aneurysm significantly reduced mortality rates at a large urban hospital, according to research presented this week at the Society for Vascular Surgery's 2009 Vascular Annual Meeting, held from June 11 to 14 in Denver.

Benjamin W. Starnes, M.D., of the University of Washington in Seattle, and colleagues compared outcomes in 131 patients who were managed before implementation of the new protocol in 2007 and 50 patients who were managed afterward.

Prior to implementation of the protocol, the researchers found that the 30-day mortality rate was 60 percent. After implementation, 18 (36 percent) of patients underwent successful endovascular aneurysm repair, 28 (46 percent) underwent open repair, and four (8 percent) received only palliative care. Endovascular aneurysm repair was associated with a significantly lower mortality rate than open repair (17 versus 46 percent), resulting in an overall 30-day mortality rate of 35 percent.

"An algorithm using early proximal aortic control with a balloon catheter, permissive hypotension, and endovascular repair when possible reduced ruptured abdominal aortic aneurysm mortality by 40 percent (absolute risk reduction of 25 percent)," the authors conclude. "Using this approach in a large, urban hospital, the majority of patients presenting with ruptured abdominal aortic aneurysm survived. Further reduction in mortality is expected as improvement in endovascular techniques allows treatment of more patients with complex aortic anatomy."

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