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The Epidemiology of Ruptured Abdominal Aortic Aneurysm (rAAA)

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Ruptured Abdominal Aortic Aneurysm

Abstract

Ruptured abdominal aortic aneurysm (rAAA) is a highly lethal entity with total mortality estimated at 80–90 %. Up until the 1990s, there was an increasing incidence of rAAA hospital admissions, but current data shows this has plateaued and is now in decline. This is likely multifactorial and coincides with a decrease in AAA incidence, most likely from decreases in smoking; increased elective treatment of elderly patients with EVAR who were not optimal candidates for open repair; and increased detection and repair of intact AAAs secondary to increased diagnostic abdominal imaging. Identification of strong risk factors for rupture remains paramount, and new models using wall stress and alternative measures to aneurysm diameter show promise in this regard. Multiple other modifiable risk factors, such as smoking and hypertension, remain target areas for improvement given their correlation with risk of rupture. Concurrently, the perioperative mortality has been decreasing despite steady to possibly decreasing turndown rates for rAAA. This change in operative mortality has occurred at the same time as the wider acceptance of endovascular repair for ruptured AAAs (rEVAR). Comparative retrospective studies have shown a benefit to rEVAR versus open repair, in terms of morbidity and mortality, although early results from the RCTs do not. Despite this, many centers, including ours, believe that rEVAR should be attempted whenever possible given the evidence available to date.

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Authors and Affiliations

  1. Department of Surgery, Division of Vascular Surgery, Beth Israel Deaconess Medical Center, 110 Francis St 5B, 300 Brookline Ave, Boston, MA, 02215, USA

    Peter A. Soden MD & Marc L. Schermerhorn MD, FACS

Authors
  1. Peter A. Soden MD
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  2. Marc L. Schermerhorn MD, FACS
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Correspondence to Marc L. Schermerhorn MD, FACS .

Editor information

Editors and Affiliations

  1. Division of Vascular Surgery, University of Washington Harborview Medical Center, Seattle, Washington, USA

    Benjamin W. Starnes

  2. Albany Medical Center, Albany, New York, USA

    Manish Mehta

  3. Bronx, New York, USA

    Frank J. Veith

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© 2017 Springer International Publishing Switzerland

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Soden, P.A., Schermerhorn, M.L. (2017). The Epidemiology of Ruptured Abdominal Aortic Aneurysm (rAAA). In: Starnes, B., Mehta, M., Veith, F. (eds) Ruptured Abdominal Aortic Aneurysm. Springer, Cham. https://doi.org/10.1007/978-3-319-23844-9_3

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  • DOI: https://doi.org/10.1007/978-3-319-23844-9_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23843-2

  • Online ISBN: 978-3-319-23844-9

  • eBook Packages: MedicineMedicine (R0)

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