Clinical Outcomes of the "Endovascular Aneurysm Repair-First" Protocol for Ruptured Abdominal Aortic Aneurysms: A 10-Year Single-Center Retrospective Study.

Objectives: The treatment of ruptured abdominal aortic aneurysms (rAAAs) remains associated with high morbidity and mortality. While endovascular aortic repair (EVAR) has shown promising results in elective settings, the evidence supporting its use as the primary treatment for patients with rAAA remains controversial. We aimed to evaluate both the clinical outcomes and the inherent advantages and disadvantages of our "EVAR-first" protocol for patients with rAAA over a 10-year period. Methods: A retrospective review of data extracted from medical records identified 93 consecutive patients with rAAA who underwent EVAR from January 2014 to January 2024. All patients were treated using the "EVAR-first" protocol. Initially, percutaneous puncture of the bilateral common femoral arteries and the left brachial artery was performed. General anesthesia was then induced with the endovascular balloon control and EVAR was performed. Results: EVAR was successfully performed in all patients with rAAA. The mean follow-up period was 1386.5 ± 1171.1 days. After the 30-day period, no new complications were observed. Endovascular re-interventions were performed in 9 patients (9.7%). The overall survival rates at 30 days, 1 year, and 3 years for the entire cohort were 87.1%, 70.9%, and 60.5%, respectively. Conclusions: This single-center experience suggests favorable outcomes for adopting the "EVAR-first" policy for all rAAA patients.