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The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Powell, JT; Sweeting, MJ; Thompson, MM; Hinchliffe, RJ; Ashleigh, R; Bell, R; Greenhalgh, RM; Thompson, SG; Ulug, P; Investigators, IMPROVET (2015) The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm. EUROPEAN HEART JOURNAL, 36 (21). 1328-U137. ISSN 0195-668X
SGUL Authors: Thompson, Matthew Merfyn

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Aims To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. Methods and results The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality, proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigated in rAAA patients randomized before morphological assessment in the Immediate Management of the Patient with Rupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwent repair and had their admission computerized tomography scan submitted to the core laboratory, were included. Among 458 patients (364 men, mean age 76 years), who had either EVAR (n = 177) or open repair (n = 281) started, there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specified plan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphological variables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length (mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI 0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameters with reinterventions. Conclusion Short aneurysm necks adversely influence mortality after open repair of rAAA and preclude conventional EVAR. This may help explain why observational studies, but not randomized trials, have shown an early survival benefit for EVAR. Clinical trial registration: ISRCTN 48334791.

Item Type: Article
Additional Information: © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
Keywords: Aneurysm, Aorta, Imaging, Rupture, Surgery, Stent grafts, Cardiovascular System & Hematology, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular & Cardiac Surgery (INCCVC)
Journal or Publication Title: EUROPEAN HEART JOURNAL
ISSN: 0195-668X
27 January 2015Published
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
Project IDFunderFunder ID
07/37/64UK Health Technology Assessment AwardUNSPECIFIED
Web of Science ID: WOS:000356186200010
Publisher's version:

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