EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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In patients presenting with a ruptured abdominal aortic aneurysms (AAA), a choice can be made whether or not to offer treatment (selective treatment policy). Patients with a realistic expectation of survival after surgery, identified by several available prediction models, can be offered two treatment options: conventional "open" surgical repair and endovascular "minimally invasive" repair. Conventional open repair carries a significant morbidity and mortality, due to the combined effects of general anaesthesia and surgical exposure. ⋯ However, these mainly observational studies show considerable heterogeneity. Furthermore, potential selection bias, selecting patients for endovascular repair constituting a haemodynamically lower-risk category with a more favourable EVAR suitable anatomic configuration, makes a proper comparison unlikely. Therefore, randomised controlled trials, although difficult to perform in an acute severe condition like ruptured AAA, are needed to identify possible benefits of EVAR over open surgery in patients with a ruptured AAA.