Endovascular Versus Open Repair Of Ruptured Abdominal Aortic Aneurysm: Does A Scoring System Work?

Background and Objectives
Despite its validity in open repair, the Hardman scoring system has not been previously described to predict outcome in Endovascular repair of Ruptured Abdominal Aortic Aneurysm (RAAA). This study aims firstly to assess the feasibility of the Hardman index in selecting patients for either open or endovascular repair in RAAA and secondly to see if this index could be used reliably to randomise patients for future studies.
Methods
Patients undergoing open and endovascular repair of RAAA over a 5-year period were identified from a prospectively collected data base. Five Hardman index factors were calculated and related to the outcome. Univariate association of the five index factors was assessed by chi-squared or logistic regression analysis. p<0.050 was considered significant.
Results
A total of 126 patients (Open repair=74, endovascular=52) with a mean age of 74 years (range 51-91) and a male to female ratio of 6.4:1 were included. The overall in-hospital mortality was 43.7%(55/126). The mortality for open repair was 51.4%(38/74) in comparison to 32.7%(17/52) for endovascular stenting. Age>76 years (p=0.04, OR2.1, 95%CI 1.0-4.7) and loss of consciousness (p=0.01, OR3.3, 95%CI 1.2-9.4) were significant predictors of mortality. The operative mortality increased with rising score (Table). Mortality for patients with scores of <2 in open group was 43.5%(20/46) in comparison to 22.9%(8/35) for endovascular group (p=0.044) whereas mortality with scores of ≥2 was 64.3%(18/28) and 52.9%(9/17) for the respective groups (p=0.329)
Conclusions
Patients with a Hardman score of <2 have significantly better outcome with endovascular as compared to open repair whereas those with a sore of ≥2 have no significant difference in outcome with either procedure and could be randomised for future studies.