腹主动脉瘤腔内治疗与传统手术治疗疗效回顾性对比分析
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摘要
目的比较腹主动脉瘤血管腔内治疗和开放手术治疗的治疗效果。方法回顾性总结我院自2000年1月1日至2010年1月1日所有真性腹主动脉瘤的患者共92例,其中成功随访开放手术患者25例,腔内治疗患者28例。通过术前情况、手术过程、围手术期死亡率和并发症、术后中远期死亡率和并发症发生率的比较进行总体评价。本项研究经t检验和非参数检验统计方法进行检验。结果对比手术组(65岁),腔内组拥有更高年龄(73岁)因素,仍然显示出缩短手术时间50%,更少的出血和输血量,甚至不用输血,以及相对轻微甚至不用处理的并发症和更少的ICU入住时间,但同时也带来了费用3倍的提高。而就无症状生存时间(这里指腹主动脉瘤相关症状)而言,腔内组从围手术期30天到最长随访8年均优于手术组(P<0.01)。而总体死亡率以及腹主动脉瘤相关死亡率,腔内组只分别显示出了术后1年和2年的优势,而从更长远的尺度上看反而是传统手术可以更好的降低死亡率。结论腹主动脉瘤腔内治疗具有安全、有效的特点,近期疗效较传统开放手术有明显优势,而传统开腹手术在术后2年甚至是更长时间上的动脉瘤相关死亡率方面仍旧显示出不可替代的优势。
To compare endovascular repair and open surgery in patients with abdominal aortic aneurysms (AAAs). Methods All consecutive conscious patients with AAAs who presented to PUMC hospital between January1,2000and January1,2010were included in this study (n=92).After that25patients by open surgery and28patients by endovascular repair were followed-up successfully. Outcomes evaluated preoperative, perio-perative, mortality, systemic complications. The statistical tests were the Student t test and non-parameter test. Results With the elder patients (73vs65), endovascular repair had shown us that reducing operation time by50%, less bleeding and less blood transfusion or even none about blood, and no less but decrease in degree in systemic complications, and less opportunity to get into the ICU, only with the3times cost by the expensive materials to the traditional open surgery. Endovascular repair also improved the asymptomatic survival time from30days after the surgery to the longest8years (P<0.01). But to the overall mortality and AAAs related mortality, EVAR only showed the advantage in the1st and2nd year. Conclusions In our highly selected population, EVAR is better only for the early period result than the open surgery and for the advantage in safety and less trauma but with much more cost.
To compare endovascular repair and open surgery in patients with abdominal aortic aneurysms (AAAs). Methods All consecutive conscious patients with AAAs who presented to PUMC hospital between January1,2000and January1,2010were included in this study (n=92).After that25patients by open surgery and28patients by endovascular repair were followed-up successfully. Outcomes evaluated preoperative, perio-perative, mortality, systemic complications. The statistical tests were the Student t test and non-parameter test. Results With the elder patients (73vs65), endovascular repair had shown us that reducing operation time by50%, less bleeding and less blood transfusion or even none about blood, and no less but decrease in degree in systemic complications, and less opportunity to get into the ICU, only with the3times cost by the expensive materials to the traditional open surgery. Endovascular repair also improved the asymptomatic survival time from30days after the surgery to the longest8years (P<0.01). But to the overall mortality and AAAs related mortality, EVAR only showed the advantage in the1st and2nd year. Conclusions In our highly selected population, EVAR is better only for the early period result than the open surgery and for the advantage in safety and less trauma but with much more cost.
引文
1. Brewster DC, Cronenwett JL, Hallett JJ, et al. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery [J]. J Vasc Surg,2003,37(5):1106-1117.
2. Scott RA, Ashton HA, Kay DN. Abdominal aortic aneurysm in 4237 screened patients:prevalence, development and management over 6 years. Br J Surg 1991; 78:1122-5.
3. Wilmink TBM, Quick CRG, Day NE. The association between cigarette smoking and abdominal aortic aneurysms. J Vase Surg 1999; 30:1099-105.
4. Lederle FA, Johnson GR, Wilson SE, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA 2002; 287:2968-72.
5. Roger M. Greenhalgh, M.D., and Janet T. Powell, M.D., Ph.D. Endovascular Repair of Abdominal Aortic Aneurysm. N Engl [j] med.2008; 5:494-501.
6. THE UNITED KINGDOM SMALL ANEURYSM TRIAL PARTICIPANTS. LONG-TERM OUTCOMES OF IMMEDIATE REPAIR COMPARED WITH SURVEILLANCE OF SMALL ABDOMINAL AORTIC ANEURYSMS. N Engl J Med,Vol.2002;19:1445-52.
7. Jan D. Blankensteijn, M.D., Sjors E.C.A. de Jong, M.D., Monique Prinssen, M.D.Arie C. van der Ham, M.D., Jaap Buth, M.D., Steven M.M. van Sterkenburg, M.D.Hence J.M. Verhagen, M.D., Erik Buskens, M.D., and Diederick E. Grobbee, M.D.,for the Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group*. Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms. n engljmed.2005;23:2398-405.
8. Frank A. Lederle, M.D. Endovascular Repair of Abdominal Aortic Aneurysm —Round Two. n engljmed.2005;23:2443-5.
9. Marc L. Schermerhorn, M.D., A. James O'Malley, Ph.D., Ami Jhaveri, M.D.Philip Cotterill, Ph.D., Frank Pomposelli, M.D., and Bruce E. Landon, M.D., M.B.A. Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population, n engl j med.2008;5:464-74.
10. Wataru Hashimoto, MD, Ichiro Sakamoto, MD, Koji Hashizume, MD.Shinichiro Taniguchi, MD, Takashi Miura, MD, Tomohiro Odate, MD.Seiji Matsukuma, MD, Kazuki Hisatomi, MD, and Kiyoyuki Eishi, MD. Seven-Year Results of Endovascular Aneurysm Repairs of Abdominal Aortic Aneurysms with Custom-Made Stent Grafts. Ann Thorac Cardiovasc Surg 2010; 16:26-30.
11. S. Marlene Grenon, MDCM, MMSC Joel Gagnon, MD. York N. Hsiang, MD. Jerry C. Chen, MD. Canadian experience with percutaneous endovascular aneurysm repair:short-term outcomes. J can chir,2009;5:E156-60.
12. Bernd M. Muehling, Karl Heinz Orend and Ludger Sunder-Plassmann. Elective infrarenal abdominal aortic aneurysm repair_ transperitoneal, retroperitoneal, endovascular? Interact CardioVasc Thorac Surg 2009;9:802-806.
13. GUO Wei, ZHANG Hong-peng, LIU Xiao-ping, YIN Tai, JIA Xin, LIANG Fa-qi and ZHANG Guo-hua. Endovascular repair:alternative treatment of rupturedabdominal aortic aneurysm. Chin Med J 2009;122(15):1728-1731.
14. Kristina A. Giles, MD; Frank B. Pomposelli, MD; Allen D. Hamdan, MD; Mark C. Wyers, MD; and Marc L. Schermerhorn, MD. Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005-07. J ENDOVASC THER.2009; 16:365-372.
15. Kristina A. Giles, MD1; Allen D. Hamdan, MD1; Frank B. Pomposelli, MD.; Mark C. Wyers, MD.; Suzanne E. Dahlberg, PhD; and Marc L. Schermerhorn, MD. Population-Based Outcomes Following Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms. J ENDOVASC THER.2009;16:554-564.
16.张永杰,霍鑫.腹主动脉瘤腔内修复与开放手术疗效初探.中国普通外科杂志,2009,18(6)：555-557.
17.管珩,杨耀国.腔内隔绝术治疗主动脉疾病与传统手术比较.外科理论与实践,2007,12(1)：1-3.
18.李梓伦,刘干斌.开放或血管腔内修复腹主动脉瘤21178例的荟萃分析[[J/CD].中华普通外科学文献：2008,2(5)：418-421.
19.陈玉帅,徐克.腹主动脉瘤腔内修复术与传统外科手术的疗效比较.中国全科医学,2008,11(12A)：2140-2142.
20.陈建华,马文锋,张健,段志泉,辛世杰.腹主动脉瘤开腹手术与腔内修复术围手术期情况的荟萃分析.中国普通外科杂志,2009,18(12)：1241-1245.
21.刘建勇,金毕,欧阳晨曦.带膜支架腔内隔绝术与人工血管置换术治疗腹主动脉瘤的风险比较.华中医学杂志,2007,31(2)：113-114.
22. Pei Ho, Wai Ki Yiu, Grace Chung-Yan Cheung, et al. Systematic review of clinical trials comparing open and endovascular treatment of abdominal aortic aneurysm [J].Surgical Practice,2006,10(1):24-37.
23. EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial[J].Lancet 2005,365(9478):2179-2186.
24. Blankensteijn JD, de Jong SE, Prinssen M,et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms [J]. N Engl J Med,2005,352(23):2398-2405.
25. Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1),30-day operative mortality results:randomized controlled trial [J]. Lancet,2004,364(9437):843-848.
26. Prinssen M, Verhoeven EL.Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms [J]. N Engl J Med,2004,351(16):1607-1618.
27. White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms:classification, incidence, diagnosis, and management [J]. J Endovasc Surg,1997,4(2):152-168.
28. Bratby MJ, Munneke GM, Belli AM,et al. How safe is bilateral internal iliac artery embolization prior to EVAR? [J]. Cardi Inter Radi,2008,31(2):246-253.
29.刘昌伟,刘暴.腹主动脉瘤腔内治疗84例分析.中国实用外科杂志.2009,29(11)：913-5.
1. Roger M. Greenhalgh, M.D., and Janet T. Powell, M.D., Ph.D. Endovascular Repair of Abdominal Aortic Aneurysm. n engljmed.2008; 5:494-501.
2. THE UNITED KINGDOM SMALL ANEURYSM TRIAL PARTICIPANTS. LONG-TERM OUTCOMES OF IMMEDIATE REPAIR COMPARED WITH SURVEILLANCE OF SMALL ABDOMINAL AORTIC ANEURYSMS. N Engl J Med,Vol.2002;19:1445-52.
3. Jan D. Blankensteijn, M.D., Sjors E.C.A. de Jong, M.D., Monique Prinssen, M.D.Arie C. van der Ham, M.D., Jaap Buth, M.D., Steven M.M. van Sterkenburg, M.D.Hence J.M. Verhagen, M.D., Erik Buskens, M.D., and Diederick E. Grobbee, M.D.,for the Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group*. Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms. n engl j med.2005;23:2398-405.
4. Frank A. Lederle, M.D. Endovascular Repair of Abdominal Aortic Aneurysm —Round Two. n engljmed.2005;23:2443-5.
5. Marc L. Schermerhorn, M.D., A. James O'Malley, Ph.D., Ami Jhaveri, M.D.Philip Cotterill, Ph.D., Frank Pomposelli, M.D., and Bruce E. Landon, M.D., M.B.A. Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population, n engl j med.2008;5:464-74.
6. Wataru Hashimoto, MD, Ichiro Sakamoto, MD, Koji Hashizume, MD.Shinichiro Taniguchi, MD, Takashi Miura, MD, Tomohiro Odate, MD,Seiji Matsukuma, MD, Kazuki Hisatomi, MD, and Kiyoyuki Eishi, MD. Seven-Year Results of Endovascular Aneurysm Repairs of Abdominal Aortic Aneurysms with Custom-Made Stent Grafts. Ann Thorac Cardiovasc Surg 2010; 16:26-30.
7. S. Marlene Grenon, MDCM, MMSC Joel Gagnon, MD. York N. Hsiang, MD. Jerry C. Chen, MD. Canadian experience with percutaneous endovascular aneurysm repair:short-term outcomes. J can chir,2009;5:E156-60.
8. Bernd M. Muehling, Karl Heinz Orend and Ludger Sunder-Plassmann. Elective infrarenal abdominal aortic aneurysm repair_transperitoneal, retroperitoneal, endovascular? Interact CardioVasc Thorac Surg 2009;9:802-806.
9. GUO Wei, ZHANG Hong-peng, LIU Xiao-ping, YIN Tai, JIA Xin, LIANG Fa-qi and ZHANG Guo-hua. Endovascular repair:alternative treatment of rupturedabdominal aortic aneurysm. Chin Med J 2009;122(15):1728-1731.
10. Kristina A. Giles, MD; Frank B. Pomposelli, MD; Allen D. Hamdan, MD; Mark C. Wyers, MD; and Marc L. Schermerhorn, MD. Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005-07. J ENDOVASC THER.2009;16:365-372.
11. Kristina A. Giles, MD1; Allen D. Hamdan, MD1; Frank B. Pomposelli, MD.; Mark C. Wyers, MD.; Suzanne E. Dahlberg, PhD; and Marc L. Schermerhorn, MD. Population-Based Outcomes Following Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms. J ENDOVASC THER.2009;16:554-564.
2. Scott RA, Ashton HA, Kay DN. Abdominal aortic aneurysm in 4237 screened patients:prevalence, development and management over 6 years. Br J Surg 1991; 78:1122-5.
3. Wilmink TBM, Quick CRG, Day NE. The association between cigarette smoking and abdominal aortic aneurysms. J Vase Surg 1999; 30:1099-105.
4. Lederle FA, Johnson GR, Wilson SE, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA 2002; 287:2968-72.
5. Roger M. Greenhalgh, M.D., and Janet T. Powell, M.D., Ph.D. Endovascular Repair of Abdominal Aortic Aneurysm. N Engl [j] med.2008; 5:494-501.
6. THE UNITED KINGDOM SMALL ANEURYSM TRIAL PARTICIPANTS. LONG-TERM OUTCOMES OF IMMEDIATE REPAIR COMPARED WITH SURVEILLANCE OF SMALL ABDOMINAL AORTIC ANEURYSMS. N Engl J Med,Vol.2002;19:1445-52.
7. Jan D. Blankensteijn, M.D., Sjors E.C.A. de Jong, M.D., Monique Prinssen, M.D.Arie C. van der Ham, M.D., Jaap Buth, M.D., Steven M.M. van Sterkenburg, M.D.Hence J.M. Verhagen, M.D., Erik Buskens, M.D., and Diederick E. Grobbee, M.D.,for the Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group*. Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms. n engljmed.2005;23:2398-405.
8. Frank A. Lederle, M.D. Endovascular Repair of Abdominal Aortic Aneurysm —Round Two. n engljmed.2005;23:2443-5.
9. Marc L. Schermerhorn, M.D., A. James O'Malley, Ph.D., Ami Jhaveri, M.D.Philip Cotterill, Ph.D., Frank Pomposelli, M.D., and Bruce E. Landon, M.D., M.B.A. Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population, n engl j med.2008;5:464-74.
10. Wataru Hashimoto, MD, Ichiro Sakamoto, MD, Koji Hashizume, MD.Shinichiro Taniguchi, MD, Takashi Miura, MD, Tomohiro Odate, MD.Seiji Matsukuma, MD, Kazuki Hisatomi, MD, and Kiyoyuki Eishi, MD. Seven-Year Results of Endovascular Aneurysm Repairs of Abdominal Aortic Aneurysms with Custom-Made Stent Grafts. Ann Thorac Cardiovasc Surg 2010; 16:26-30.
11. S. Marlene Grenon, MDCM, MMSC Joel Gagnon, MD. York N. Hsiang, MD. Jerry C. Chen, MD. Canadian experience with percutaneous endovascular aneurysm repair:short-term outcomes. J can chir,2009;5:E156-60.
12. Bernd M. Muehling, Karl Heinz Orend and Ludger Sunder-Plassmann. Elective infrarenal abdominal aortic aneurysm repair_ transperitoneal, retroperitoneal, endovascular? Interact CardioVasc Thorac Surg 2009;9:802-806.
13. GUO Wei, ZHANG Hong-peng, LIU Xiao-ping, YIN Tai, JIA Xin, LIANG Fa-qi and ZHANG Guo-hua. Endovascular repair:alternative treatment of rupturedabdominal aortic aneurysm. Chin Med J 2009;122(15):1728-1731.
14. Kristina A. Giles, MD; Frank B. Pomposelli, MD; Allen D. Hamdan, MD; Mark C. Wyers, MD; and Marc L. Schermerhorn, MD. Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005-07. J ENDOVASC THER.2009; 16:365-372.
15. Kristina A. Giles, MD1; Allen D. Hamdan, MD1; Frank B. Pomposelli, MD.; Mark C. Wyers, MD.; Suzanne E. Dahlberg, PhD; and Marc L. Schermerhorn, MD. Population-Based Outcomes Following Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms. J ENDOVASC THER.2009;16:554-564.
16.张永杰,霍鑫.腹主动脉瘤腔内修复与开放手术疗效初探.中国普通外科杂志,2009,18(6)：555-557.
17.管珩,杨耀国.腔内隔绝术治疗主动脉疾病与传统手术比较.外科理论与实践,2007,12(1)：1-3.
18.李梓伦,刘干斌.开放或血管腔内修复腹主动脉瘤21178例的荟萃分析[[J/CD].中华普通外科学文献：2008,2(5)：418-421.
19.陈玉帅,徐克.腹主动脉瘤腔内修复术与传统外科手术的疗效比较.中国全科医学,2008,11(12A)：2140-2142.
20.陈建华,马文锋,张健,段志泉,辛世杰.腹主动脉瘤开腹手术与腔内修复术围手术期情况的荟萃分析.中国普通外科杂志,2009,18(12)：1241-1245.
21.刘建勇,金毕,欧阳晨曦.带膜支架腔内隔绝术与人工血管置换术治疗腹主动脉瘤的风险比较.华中医学杂志,2007,31(2)：113-114.
22. Pei Ho, Wai Ki Yiu, Grace Chung-Yan Cheung, et al. Systematic review of clinical trials comparing open and endovascular treatment of abdominal aortic aneurysm [J].Surgical Practice,2006,10(1):24-37.
23. EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial[J].Lancet 2005,365(9478):2179-2186.
24. Blankensteijn JD, de Jong SE, Prinssen M,et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms [J]. N Engl J Med,2005,352(23):2398-2405.
25. Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1),30-day operative mortality results:randomized controlled trial [J]. Lancet,2004,364(9437):843-848.
26. Prinssen M, Verhoeven EL.Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms [J]. N Engl J Med,2004,351(16):1607-1618.
27. White GH, Yu W, May J, et al. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms:classification, incidence, diagnosis, and management [J]. J Endovasc Surg,1997,4(2):152-168.
28. Bratby MJ, Munneke GM, Belli AM,et al. How safe is bilateral internal iliac artery embolization prior to EVAR? [J]. Cardi Inter Radi,2008,31(2):246-253.
29.刘昌伟,刘暴.腹主动脉瘤腔内治疗84例分析.中国实用外科杂志.2009,29(11)：913-5.
1. Roger M. Greenhalgh, M.D., and Janet T. Powell, M.D., Ph.D. Endovascular Repair of Abdominal Aortic Aneurysm. n engljmed.2008; 5:494-501.
2. THE UNITED KINGDOM SMALL ANEURYSM TRIAL PARTICIPANTS. LONG-TERM OUTCOMES OF IMMEDIATE REPAIR COMPARED WITH SURVEILLANCE OF SMALL ABDOMINAL AORTIC ANEURYSMS. N Engl J Med,Vol.2002;19:1445-52.
3. Jan D. Blankensteijn, M.D., Sjors E.C.A. de Jong, M.D., Monique Prinssen, M.D.Arie C. van der Ham, M.D., Jaap Buth, M.D., Steven M.M. van Sterkenburg, M.D.Hence J.M. Verhagen, M.D., Erik Buskens, M.D., and Diederick E. Grobbee, M.D.,for the Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group*. Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms. n engl j med.2005;23:2398-405.
4. Frank A. Lederle, M.D. Endovascular Repair of Abdominal Aortic Aneurysm —Round Two. n engljmed.2005;23:2443-5.
5. Marc L. Schermerhorn, M.D., A. James O'Malley, Ph.D., Ami Jhaveri, M.D.Philip Cotterill, Ph.D., Frank Pomposelli, M.D., and Bruce E. Landon, M.D., M.B.A. Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population, n engl j med.2008;5:464-74.
6. Wataru Hashimoto, MD, Ichiro Sakamoto, MD, Koji Hashizume, MD.Shinichiro Taniguchi, MD, Takashi Miura, MD, Tomohiro Odate, MD,Seiji Matsukuma, MD, Kazuki Hisatomi, MD, and Kiyoyuki Eishi, MD. Seven-Year Results of Endovascular Aneurysm Repairs of Abdominal Aortic Aneurysms with Custom-Made Stent Grafts. Ann Thorac Cardiovasc Surg 2010; 16:26-30.
7. S. Marlene Grenon, MDCM, MMSC Joel Gagnon, MD. York N. Hsiang, MD. Jerry C. Chen, MD. Canadian experience with percutaneous endovascular aneurysm repair:short-term outcomes. J can chir,2009;5:E156-60.
8. Bernd M. Muehling, Karl Heinz Orend and Ludger Sunder-Plassmann. Elective infrarenal abdominal aortic aneurysm repair_transperitoneal, retroperitoneal, endovascular? Interact CardioVasc Thorac Surg 2009;9:802-806.
9. GUO Wei, ZHANG Hong-peng, LIU Xiao-ping, YIN Tai, JIA Xin, LIANG Fa-qi and ZHANG Guo-hua. Endovascular repair:alternative treatment of rupturedabdominal aortic aneurysm. Chin Med J 2009;122(15):1728-1731.
10. Kristina A. Giles, MD; Frank B. Pomposelli, MD; Allen D. Hamdan, MD; Mark C. Wyers, MD; and Marc L. Schermerhorn, MD. Comparison of Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms From the ACS-NSQIP 2005-07. J ENDOVASC THER.2009;16:365-372.
11. Kristina A. Giles, MD1; Allen D. Hamdan, MD1; Frank B. Pomposelli, MD.; Mark C. Wyers, MD.; Suzanne E. Dahlberg, PhD; and Marc L. Schermerhorn, MD. Population-Based Outcomes Following Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms. J ENDOVASC THER.2009;16:554-564.