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Ann Vasc Dis. 2013;6(2):169-74. doi: 10.3400/avd.oa.12.00085. Epub 2013 Apr 20.

Protocol-based strategy for endovascular repair of ruptured abdominal aortic aneurysms.

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Division of Vascular Surgery, Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan.



Compared with conventional open surgery (COS), endovascular aneurysm repair (EVAR) has been reported to decrease the 30-day mortality rate in patients with ruptured abdominal aortic aneurysms (rAAAs). We developed an EVAR-first strategy for rAAAs that incorporates the Shonan ruptured abdominal aortic aneurysm protocol (SRAP). We describe short-term results with this protocol at our institution and compare them with outcomes in patients who underwent COS.


The records of all 57 patients in whom a rAAA was repaired during a 7-year period were reviewed retrospectively. Patients in the COS group (n = 30) were treated between January 2005 and December 2009; those in the SRAP group (n = 27) were treated between January 2010 and March 2012. The two groups were compared with respect to patient characteristics at admission, including severity of condition; operative and in-hospital variables; and 30-day mortality.


The baseline patient characteristics in the COS and SRAP groups were similar except that the SRAP group had a significantly higher rate of cerebrovascular disease. The 30-day mortality rate was significantly higher in the COS group (43% vs. 19%), as were the intraoperative mortality rate (27% vs. 5%) and the in-hospital mortality rate (57% vs. 26%; P < 0.05 for all comparisons). The technical success rate for EVAR was 96%; no conversions to open surgery were required.


Use of the SRAP is a promising strategy for improving initial outcomes in patients with rAAAs.


EVAR; abdominal aortic aneurysm; rupture

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