Exploring Life After Ruptured AAA Repair: A Five-Year Perspective

This multicentre retrospective cohort study offers a rare long-term perspective on patient outcomes following emergency repair of ruptured abdominal aortic aneurysms (rAAA) via either endovascular aneurysm repair (EVAR) or open surgical repair (OSR). Conducted across five Dutch teaching hospitals, it provides essential insight into survival, quality of life (QoL), health status, and residential destination after a life-threatening vascular emergency.

Of 349 treated patients, nearly half underwent EVAR. While 30-day, one-year, and five-year survival rates stood at 74.2%, 66.0%, and 45.0% respectively, these did not differ significantly between EVAR and OSR. At a mean follow-up of nearly five years, almost half of the surviving patients lived independently at home—a notable finding in the context of emergency vascular surgery.

QoL and health status were assessed using WHOQOL-BREF and EQ-5D-5L instruments. No significant differences emerged between treatment modalities. However, younger patients (<80 years) reported better physical health and greater independence in daily activities, suggesting age remains a critical determinant of long-term functional recovery.

Crucially, although EVAR patients were more often discharged directly home, this benefit diminished over time. Long-term outcomes appear comparable between EVAR and OSR, supporting the appropriateness of either modality in selected patients.

These findings underscore the need to consider not just survival but the holistic trajectory of recovery after rAAA. For surgeons, the message is clear: age alone should not exclude patients from intervention, but realistic expectations and long-term support planning are essential.