Huang Bin: Experience in the treatment of ruptured abdominal aortic aneurysms

Ruptured abdominal aortic aneurysm (RAAA) is one of the most challenging and life-threatening diseases in vascular surgery.
current treatments include open surgery (OR) and abdominal aortic aneurysm in-cavity repair (EVAR), and it remains to be determined which type of treatment works better.
On June 22, 2019, dr. Huang Bin, Deputy Director of Vascular Surgery from Huaxi Hospital of Sichuan University, gave a wonderful speech on the experience of treating ruptured abdominal aortic aneurysm at the 3rd National Vascular Health Management Summit Forum and the 6th Shenzhen-Hong Kong-Macau Vascular Forum held in Shenzhen.
single-center data were included in 107 RAAA cases treated by vascular surgery at Huaxi Hospital, Sichuan University, from April 1999 to January 2019, including 86 OR patients and 21 EVAR patients.
the EVAR group age (68±7 vs. 57±11 years old, P s 0.020), COPD ratio (58% vs. 24%, P s 0.002) is higher than or group; surgery time is shorter than OR group (138±20 vs. 258±66 min, P s 0.00).
the bleeding EVAR group was lower than the OR group (130±43 vs. 2295±425 mL, P .00).
the EVAR group, such as ICU reside time, standby time and postoperative fasting time, were better than the OR group.
3 deaths during perioperative surgery in the EVAR group and 13 deaths in the OR group, no significant difference between the two groups of 30-day mortality (22% vs. 25%, P .729), and the incidence of serious complications after surgery, and no statistical difference between the two groups (33.3% vs. 32.2%, P .900).
a forward-looking randomized controlled study from 2014: RAAA patients with 613 clinically diagnosed cases, 316 in the EVAR group, 297 in the OR group, and no statistical difference in mortality in the EVAR and OR groups (35.4% vs. 37.4%, P .62).
a prospective randomized controlled study of 520 RAAA patients published by Reimerink, among others, showed that the rate of renal insanity was lower in the EVAR group than in the OR group (11% vs. There was no statistical difference between the two groups of 30 days after surgery (21% vs. 25%, P >0.05) and other postoperative complications;
in recent years, four randomized controlled trials have been published in Europe: the results show no statistical differences in survival rates between EVAR and OR in the 30 days after surgery for the treatment of RAAA.
meta-analysis published in 2017: 761 RAAA patients in four randomized controlled studies showed no statistically significant statistical differences in mortality and postoperative complications over 30 days of hospitalization in the EVAR and OR groups.
meta-analysis of postoperative celiac hypertension syndrome in EVAR: 1,134 patients with RAAA line EVAR had an overall perioperative mortality rate of 21% and an overall abdominal hypertension syndrome of 8%, while the study revealed a clear linear correlation between hemodynamic instability and perioperative mortality caused by EVAR postoperative celiac hypertension syndrome in RAAA patients.
a comparative study of EVAR and OR postoperative celiac hypertension syndrome in RAAA patients: The results showed a slightly higher risk of Celiac hypertension syndrome in the OR group after surgery (21% vs. vs. 34%, P>0.05), but no statistical differences, and the results also showed a higher mortality rate (P<0.05) in patients with celiac hypertension in the EVAR group, and a higher rate of multiple organ failure, isothemia and sepsis in patients with Celiac hypertension in the OR group (P<0.05).
how to improve RAAA treatment success rate1, establish a standardized treatment process and team.
2, the amount of fluid after the emergence of low blood pressure limit, while preparing a good blood source;
3, as soon as possible placed compliance balloon blocking control further bleeding.
4, complete surgical facilities, preferably hybrid operating rooms with CT.
5, with a wealth of open-choice and EVAR technical experience of physicians, complete cladding support system equipment and auxiliary cavity technology and equipment.
6, early identification and treatment of celiac hypertension and celiac gap syndrome.
total RAAA treatment still needs to accumulate experience, fast and effective treatment process and skilled open and EVAR technology is expected to improve the success rate of treatment, two types of choice need to take into account the hospital conditions and physician experience.
further research is needed on the time and characteristics of RAAA pathophysiological patients and close monitoring of complications in the EVAR and OR processes, establishing RAAA treatment processes and teams and green passages from the emergency room to the operating room.
clinical studies and RCT tips for the selection of open and in-cavity treatment RAAA results are not significant differences, and clinical evidence-based medical research needs to be further improved.