***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To date , there are no published reports comparing hemodynamically (Hd)-stable and Hd-unstable patients with ruptured abdominal aortic aneurysms ( r-AAAs ) undergoing endovascular aneurysm repair ( EVAR ) . This study evaluates outcomes of EVAR for r-AAA based on patient 's Hd status METHODS From 2002 to 2011 , 136 patients with r-AAAs underwent EVAR  and were categorized into two groups based on systolic blood pressure ( SBP ) measurements before EVAR : 92 ( 68 % ) Hd-stable ( SBP ≥ 80 mm Hg ) and 44 ( 32 % ) Hd-unstable ( SBP < 80 mm Hg for > 10 minutes ) . All data were prospect ively entered in a data base and retrospectively analyzed . Outcomes included 30-day mortality , postoperative complications , the need for secondary re interventions , and midterm mortality . The effect of potential predictors on 30-day mortality was assessed by χ(2 ) and logistic regression . RESULTS Of the 136 r-AAA patients with EVAR , the Hd-stable and Hd-unstable groups had similar comorbidities ( coronary artery disease , 63 % vs 59 % ; hypertension , 72 % vs 75 % ; chronic obstructive pulmonary disease , 21 % vs 26 % ; and chronic renal insufficiency , 18 % vs 18 % ) , mean AAA maximum diameter ( 6.6 vs 6.4 cm ) , need for on-the-table conversion to open surgical repair ( 3 % vs 7 % ) , and incidences of nonfatal complications ( 43 % vs 38 % ) and secondary interventions ( 23 % vs 25 % ) . Preoperative computed tomography scan was available in significantly fewer Hd-unstable patients ( 64 % vs 100 % ; P < .05 ) . Compared with Hd-stable patients , the Hd-unstable patients had a significantly higher intraoperative need for aortic occlusion balloon ( 40 % vs 6 % ; P < .05 ) , mean estimated blood loss ( 744 vs 363 mL ; P < .05 ) , incidence of developing abdominal compartment syndrome ( ACS ; 29 % vs 4 % ; P < .01 ) , and death ( 33 % vs 18 % ; P < .05 ) . ACS was a significant predictor of death ; death in all r-EVAR with ACS was significantly higher compared with all r-EVAR without ACS ( 10 of 17 [ 59 % ] vs 22 of 119 [ 18 % ] ; P < .01 ) . CONCLUSIONS EVAR for r-AAA is feasible in Hd-stable and Hd-unstable patients , with a comparable incidence of conversion to open surgical repair , nonfatal complications , and secondary interventions . Hd-stable patients have reduced mortality at 30 days , whereas Hd-unstable patients require intraoperative aortic occlusion balloon more frequently , and have an increased risk for developing ACS and death INTRODUCTION EVAR has the potential to improve outcome after ruptured abdominal aortic aneurysm ( AAA ) . Published series have been based upon selected population s. METHODS An interim analysis of a single centre prospect i ve r and omised controlled trial comparing endovascular aneurysm repair ( EVAR ) with open aneurysm repair ( OAR ) in patients with ruptured AAA was performed . Patients who had a ruptured AAA and who were considered fit for open repair were r and omised to EVAR or OAR  after consent had been obtained . Those in the EVAR group had pre-operative spiral computed tomographic angiography ( CTA ) . The primary endpoint was operative ( 30-day ) mortality and secondary endpoints were moderate or severe operative complications , hospital stay and time between diagnosis and operation . A power study calculation required 100 patients to be recruited . RESULTS Between September 2002 and December 2004 , 103 patients were admitted with suspected ruptured AAA . Only 32 patients were recruited to the study . Of these , four patients died before receiving surgical treatment . On an intention to treat basis the 30-day mortality rate was 53 % in the EVAR group and 53 % in the OAR group . Moderate or severe operative complications occurred in 77 % in the EVAR group and in 80 % in the OAR group . Median total hospital stay in the EVAR group was 10 days ( inter-quartile range 6 - 28 ) and 12 days ( 4 - 52 ) in the OAR group . Median time between diagnosis and operation was 75 minutes ( 64 - 126 ) in the EVAR group and 100 minutes ( 48 - 138 ) in the OAR group . CONCLUSIONS Despite the relative high operative mortality in the EVAR group , these preliminary results show that it is possible to recruit patients to a r and omised trial of OAR and EVAR in patients with ruptured AAA . CT scanning does not delay treatment OBJECTIVE Endovascular aneurysm repair ( EVAR ) decreases 30-day mortality for patients with ruptured abdominal aortic aneurysms ( r-AAAs ) compared with open surgical repair ( OSR ) . However , which patients benefit or whether there is any long-term survival advantage is uncertain . METHODS From 2002 to 2011 , 283 patients with r-AAA underwent EVAR ( n = 120 [ 42.4 % ] ) or OSR ( n = 163 [ 57.6 % ] ) at Albany Medical Center . All data were collected prospect ively . Patients were analyzed on an intention-to-treat basis , and outcomes were evaluated by a logistic regression multivariable model . Kaplan-Meier analysis was used to compare long-term survival . RESULTS The EVAR patients had a significantly lower 30-day mortality than did the OSR patients ( 29/120 [ 24.2 % ] vs 72/163 [ 44.2 % ] ; P < .005 ) and better cumulative 5-year survival ( 37 % vs 26 % ; P < .005 ) . Men benefited more from EVAR ( mortality : 20.9 % for EVAR vs 44.3 % for OSR ; P < .001 ) than did women ( mortality : 32.4 % vs 43.9 % ; P = .39 ) . Age ≥80 years was a significant predictor of death for EVAR ( odds ratio [ OR ] , 1.07 ; P = .003 ) but not for OSR ( OR , 1.04 ; P = .056 ) . Preexisting hypertension was a significant predictor of survival for both EVAR ( OR , 0.17 ; P < .001 ) and OSR ( OR , 0.48 ; P = .021 ) . Almost one fourth of EVAR patients ( 21/91 [ 23.1 % ] ) required secondary interventions . Survival advantage was maintained for EVAR patients to 5 years . CONCLUSIONS For r-AAA , EVAR reduces the 30-day mortality and improves long-term survival up to 5 years . However , whereas open survivors require few graft-related interventions , up to 23 % of EVAR patients will require reintervention for endoleaks or graft migration . Close follow-up of all EVAR survivors is m and atory OBJECTIVES Our institution treats about 30 patients per year with ruptured abdominal aortic aneurysms ( rAAA ) . Between 2002 and 2007 , our 30-day mortality averaged 58 % . In July 2007 , we implemented an algorithm to promote endovascular aneurysm repair ( EVAR ) when feasible . This report describes the outcome with this approach . METHODS Data on patients presenting with rAAA between July 1 , 2002 , and June 30 , 2007 , were review ed and used for comparison to prospect ively collected data . Data on patients presenting between July 1 , 2007 , and April 30 , 2009 , were collected on all patients after implementation of a structured protocol . The primary outcome measure was 30-day mortality . Data were analyzed using logistic regression . Kaplan-Meier survival curves and a log-rank test were performed to compare survival times for three groups ( pre- protocol , post- protocol with open surgery , and post- protocol with EVAR ) . RESULTS During the study period , 187 patients with rAAA presented to our institution . Before implementation of the algorithm , 131 patients with rAAA presented and 128 were treated . The 30-day mortality rate was 57.8 % . After implementation of the protocol , 56 patients with rAAA were managed . Twenty-seven patients ( 48 % ) underwent successful EVAR , and 24 patients ( 43 % ) underwent open repair . Five patients ( 9 % ) underwent comfort care only . In the post- protocol period , 5 patients in the EVAR group ( 18.5 % ) and 13 patients in the open group ( 54.2 % ) died during the follow-up period for an overall 30-day mortality rate of 35.3 % ( P = .008 vs 57.8 % pre- protocol ) . After implementation of a structured protocol for managing rAAA , there was a relative risk reduction in 30-day mortality of 35 % compared to the time before implementation of the protocol ( 95 % confidence interval [ CI ] , 14%-51 % ) corresponding to an absolute risk reduction of 22.5 % ( 95 % CI , 6.8%-38.2 % ) and an odds ratio of 0.40 ( 95 % CI , 0.20 - 0.78 ; P = .007 ) . After adjusting for key factors predicting mortality , the odds ratio is 0.25 ( 95 % CI , 0.10 - 0.57 ; P = .001 ) . CONCLUSION Use of an algorithm favoring endovascular repair result ed in a highly significant reduction in rAAA mortality in our urban hospital . Thirty-day mortality for open repair was no different between pre- and post- protocol eras . With modern techniques of resuscitation and surgical management , a majority of patients presenting with rAAA can survive OBJECTIVES The aim of this study was to compare all in-hospital mortality for ruptured abdominal aortic aneurysms ( rAAAs ) before and after the establishment of an  emergency EVAR ( eEVAR ) service . DESIGN AND METHODS An eEVAR service was established in January 2006 , since when all patients presenting with rAAAs have been considered for endovascular repair . Data for all rAAAs presenting between January 2006 and December 2007 was prospect ively collected ( Group 1 ) . This patient group was compared to those presenting with rAAA between January 2003 and December 2005 when eEVAR was not offered at our institution ( Group 2 ) . These records had also been collected prospect ively and su bmi tted to the National Vascular Data base ( NVD ) . RESULTS A total of 50 rAAAs ( 17 eEVAR , 29 open repairs , 4 palliated ) presented after the introduction of  eEVAR  ( Group 1 ) and 71 in the historical Group 2 of which 54 underwent open repair and 17 were palliated . The total in-hospital mortality was significantly lower in Group 1 20 % ( eEVAR ( n=1 ) , 6 % : Open ( n=5 ) , 17 % : palliated ( n=4 ) , 100 % ) when compared to Group 2 54 % ( Open ( n=21 ) , 39 % : palliated ( n=17 ) , 100 % ) ( p=0.000001 ) . Furthermore similar significant differences were seen in 30-day operative mortalities between the two groups 13 % in Group 1 versus 39 % in Group 2 ( p=0.0003 ) . In addition the proportion of patients who were palliated has significantly decreased ( 8 % Group 1 versus 24 % Group 2 , p=0.01 ) . CONCLUSIONS The establishment of an eEVAR service has significantly reduced in-hospital mortality for patients presenting with ruptured abdominal aortic aneurysms AIM Several studies have shown the feasibility of endovascular repair of ruptured abdominal aortic aneurysms ( rEVAR ) . However , the role and value of rEVAR remains controversial due to selection bias and lack of long-term results . In the present study we describe our short- and long-term results of treating patients with rEVAR irrespective of hemodynamic condition and challenging anatomy . METHODS In April 2006 we started the single centre prospect i ve non-r and omised Ruptured Aneurysm Study ( RASA ) . During a four year enrolment period all consecutive patients presenting with infrarenal ruptured AAA ( rAAA , N.=117 ) were assessed for preferential rEVAR treatment . A rAAA was defined as extravasation of blood or hematoma outside the AAA due to transmural tear in the infrarenal abdominal aorta wall documented by preoperative computed tomography ( CT ) angiography examination or during open repair . Patients with challenging anatomy ( infrarenal neck length below 15 mm and neck angulation above 60 degrees ) were included as part of a damage control concept . Complication and mortality rates were studied at 30 days and yearly afterwards . RESULTS Thirty-five patients ( 33 % of all 
    Output:
    
However , after the introduction of EVAR and OPEN protocol s , the overall mortality for RAAA was reduced compared with the only OPEN option , suggesting a beneficial effect of EVAR in selected cases