Rate and Predictability of Graft Rupture After Endovascular and Open Abdominal Aortic Aneurysm Repair: Data From the EVAR Trials

Objective:To assess the rate and factors associated with rupture after endovascular aneurysm repair (EVAR) or open repair (OR) of abdominal aortic aneurysm. Background:Graft rupture after EVAR has been reported, often preceded by graft-related complications. Graft rupture has also been reported after OR. Methods:By July 2009, a total of 848 elective EVARs and 594 elective ORs were performed in the United Kingdom EVAR trials 1 and 2. Patients were followed up for complications, reinterventions, and rupture. The incidence of rupture was explored in relation to baseline anatomy and subsequent complications in a Cox regression analysis. Results:There were no ruptures in the OR patients. A total of 27 ruptures occurred after EVAR during a mean follow-up of 4.8 years: crude rate = 0.7 [95% confidence interval (CI): 0.5–1.0] ruptures per 100 person-years. Eighteen patients (67%) died within 30 days of rupture. Five ruptures occurred in the first 30 postoperative days and 22 after that: crude rates of rupture = 7.2 (95% CI: 3.0–17.4) and 0.6 (95% CI: 0.4–0.9) per 100 person-years, respectively. Previous complications (endoleak type 1, type 2 with sac expansion, type 3, migration or kinking) increased the risk of rupture, adjusted hazard ratio 8.83 (95% CI 3.76–20.76), P < 0.0001. Conclusions:There were no ruptures after OR and a low rate after EVAR. Mortality after graft rupture is high and previous serious complications are significantly associated with the risk of rupture. Few ruptures after EVAR seem to be spontaneous without complications identified during optimal surveillance.