Treatment of ruptured abdominal aortic aneurysms in the Amsterdam area

This thesis focuses on the treatment and outcome of patients with ruptured aneurysm of the abdominal aorta (rAAA), and in particular on the treatment with endovascular aneurysm repair (EVAR).
After introduction of the minimally invasive endovascular technique in elective aneurysm repair, the hypothesis was that in the acute patient, the advantage would be more significant. Earlier observational studies of EVAR for rAAA suggested a significant reduction in mortality and complications compared to the conventional open repair (OR). However, these observational studies were flawed by selection bias. To create an objective comparison between the two treatments, the Amsterdam Acute Aneurysm Trial described in this thesis was designed.
Alongside, a systematic review was performed to assess the total mortality of both community and in hospital patients with rAAA. Next to this, a study of all rAAA in the Amsterdam region is presented. Analysis of regional cooperation and mortality after correction for hemodynamic stability and treatment centre were performed to minimize bias.
Next to this the process of assessing anatomic suitability was studied. The possibilities of using semiautomatic software to help determining suitability in particular. Finally the influence of anatomic suitability on outcome after open repair was studied.
In the randomized trial, a non-significant difference of 5.4% (ARR -13 - 23%) between EVAR and OR was observed on 30 day mortality and severe complications. The regional cooperation implemented for the trial showed to be effective and referral was not associated with a higher mortality.