The abdominal aorta is the main artery supplying blood to the lower part of the body. An abnormal ballooning and weakening of the wall of the aorta (aortic aneurysm) particularly affects men as they grow older. An aneurysm may progressively enlarge without obvious symptoms yet it is potentially lethal as the aneurysm can burst (rupture) causing massive internal bleeding. Death is inevitable unless the bleeding can be stopped and blood flow to the lower body restored promptly. Until recently this required an open operation (laparotomy) to clamp the abdominal aorta and replace the segment of the aorta with a synthetic artery tube-graft. Many patients do not survive this major operation due to the effects of massive bleeding or failure of vital organs, such as the heart, lungs, and kidneys, despite improvements in the surgical technique and care of the critically ill patient.
A recent minimally invasive technique, termed endovascular treatment, allows the surgeon to pass a stent graft through the blood vessels from the groin to the site of rupture where it is positioned and attached to healthy artery above and below the aneurysm to stop bleeding and form a new channel for blood flow. This technique is successful in suitable patients for the planned treatment of non-ruptured aneurysms and can reduce early postoperative complications and deaths.
The present review looked at the available evidence for endovascular repair effectiveness compared with open surgery for ruptured aneurysms. Three studies, with a total of 761 participants were included. Risk of bias was generally low but one study did not adequately report randomisation methods, two studies did not report on outcomes identified in their protocol, and one study may not have included enough participants to answer the questions they intended. From the data currently available there appears to be no difference in death within 30 days of the procedure between endovascular repair and open repair. The data on complications are not robust enough at this point to make any conclusions on superiority of either repair technique, nor on outcomes at six months or cost differences per patient. More studies are needed to get a better understanding of whether or not one of the aneurysm repair techniques, endovascular or open surgical, are superior based on patient outcomes.