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The Epidemiology of Ruptured Abdominal Aortic Aneurysm (rAAA)

  • Peter A. Soden
  • Marc L. SchermerhornEmail author
Chapter

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.

Keywords

Epidemiology Rupture rAAA Risk factors Incidence Mortality 

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Surgery, Division of Vascular SurgeryBeth Israel Deaconess Medical CenterBostonUSA

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