***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: The aim of the paper is to prospect ively describe early and mid-term outcomes for emergency endovascular aneurysm repair ( eEVAR ) versus open surgery in acute abdominal aortic aneurysms ( aAAAs ) , both unruptured ( symptomatic ) and ruptured . We enrolled all consecutive patients treated for aAAA at our center between April 2002 and April 2008 . The main outcome parameters were 30-day , 6- and 12-month mortality ( all-cause and aneurysm-related ) . Two hundred forty patients were enrolled in the study . In the unruptured aAAA group ( n = 111 ) , 47 ( 42 % ) underwent eEVAR . The 30-day , 6- and 12-month mortality rates were 6 , 13 and 15 % in the eEVAR group versus 11 % ( NS ) , 13 % ( NS ) and 16 % ( NS ) in the open group , respectively . In the ruptured aAAA group ( n = 129 ) , 25 ( 19 % ) underwent eEVAR ( mortality rates : 20 , 28 and 36 % , respectively ) compared with 104 ( 81 % ) patients who underwent open surgery ( mortality rates : 45 % ( P = 0.021 ) , 60 % ( P = 0.004 ) and 63 % ( P = 0.014 ) , respectively ) . In conclusion , the present study showed a reduced 30-day , 6- and 12-month mortality of eEVAR compared with open surgery in all patients with aAAA , mainly due to a lower mortality in the ruptured aAAA group . Late aneurysm-related mortality occurred only in the eEVAR group Endovascular aortic repair ( EVAR ) treatment for ruptured aortoiliac aneurysms ( rAIA ) avoids the additional surgical insult to physiology that comes with laparotomy and open repair ( OR ) . In systematic review s , the pooled mortality rate from rAIA after EVAR is around 20 % and morbidity around 40 % . The proportion of patients with rAIA treated by EVAR is steadily increasing , as most centers are adopting an EVAR as a first line therapy . However , two trials , one r and omized ( n = 32 ) and one nonr and omized , failed to demonstrate any benefit of EVAR to OR . The multicentric r and omized study named ECAR ( for Endosvasculaire vs Chirurgie dans les Anévrysmes Rompus ) was setup on 160 patients to compare the EVAR vs OR in rAIA . The primary outcome is mortality at 1 month . The study started in January 2008 and is still in progress OBJECTIVE Emergency Endovascular Aortic Aneurysm Repair ( eEVAR ) is a rapidly evolving approach to ruptured Abdominal Aortic Aneurysms ( rAAA ) . Yet longer-term outcomes following eEVAR remain unclear . This study compares mid-term outcomes of eEVAR and open rAAA . METHODS A prospect i ve data base for all patients undergoing eEVAR and open rAAA from January 2006 to April 2010 was analysed . Patients were offered eEVAR if anatomically suitable . RESULTS 52 patients ( 45 male , median age 78 years ( 62 - 92 years ) , underwent eEVAR , 50 patients ( 44 male , median age = 71 ( 62 - 95 years ) underwent open rAAA repair .  In-hospital mortalities were 12 % ( 6/52 ) for eEVAR , 32 % ( 16/50 ) for open repair . There were five re- interventions ( 10 % ) in the eEVAR group . The peri-operative survival benefits of eEVAR over open rAAA repair were maintained at 1 and 2 years post-operatively with open repair demonstrating a two-fold increased risk of mortality ( Hazard ratio 2.2 , Fisher Exact test , 95 % Confidence Interval ( CI ) 1.108 - 4.62 , p = 0.0122 ) . Overall survival was 81 % at 1 year , 73 % at 2 years for eEVAR , and 62 % at 1 year and 52 % at 2 years for open rAAA repair . CONCLUSION EEVAR is associated with excellent mid-term survival in this cohort . We would recommend eEVAR as the management of choice for rAAA in anatomically suitable patients where local facilities and expertise exist 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 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 admitted rAAA ) were treated with rEVAR and 42 % of them were considered hemodynamically unstable ( systolic blood pressure < 100 mmHg ) and 30 % had challenging AAA anatomy . The mortality rate at 30 days in the rEVAR group was 17 % , in the open repair group 31 % , and in the entire rAAA group ( including abstained patients ) 36 % . During the first 30 days , 18 rEVAR patients experienced complications with nine re- interventions as a result . Long-term mortality of the rEVAR patients was 34 % after a median follow-up of 3.4 years . All deaths after one year follow-up were non-AAA related . Multivariate analysis shows that Hardman index , presence of peripheral arterial obstructive disease and lowest systolic blood pressure during surgery are independently associated with long-term survival . Challenging rAAA anatomy was not associated with impaired survival . CONCLUSION Our study shows that rEVAR is feasible irrespective of hemodynamic condition and that it is associated with relative low mortality rates . Challenging rAAA anatomy may not affect overall long-term survival , but six out of ten patients remain unsuitable for rEVAR because of inappropriate anatomy INTRODUCTION The successful application of endovascular techniques for the elective repair of abdominal aortic aneurysms ( AAAs ) has stimulated a strong interest in their possible use in dealing with a long-st and ing surgical challenge : the ruptured abdominal aortic aneurysm ( RAAA ) . The use of a conventional open procedure to repair ruptured aneurysms is associated with a high operative mortality of 45 % to 50 % . In this study , we evaluated the current frequency of  endovascular repair of RAAAs in four large states and the impact of this technique on patient outcome . METHODS We examined discharge data sets from 2000 through 2003 from the four states of California , Florida , New Jersey , and New York , whose combined population represents almost a third of the United States population . Proportions and trends were analyzed by chi2 analysis and continuous variables by the Student 's t test . RESULTS We found that since the year 2000 , endovascular repair has begun to emerge as a viable treatment option for RAAAs , accounting for the repair of 6.2 % of cases in 2003 . During the same period , the use of open procedures for RAAAs declined . The overall mortality rate for the 4-year period was significantly lower for endovascular vs open repair ( 39.3 % vs. 47.7 % , P = .005 ) . Moreover , compared with open repair , endovascular repair result ed in a significantly lower rate of pulmonary , renal , and bleeding complications . Survival after endovascular repair correlated with hospital experience , as assessed by the overall volume of elective and nonelective endovascular procedures . For endovascular repairs , mortality ranged from 45.9 % for small volume hospitals to 26 % for large volume hospitals ( P = .0011 ) . Volume was also a determinant of mortality for open repairs , albeit to a much lesser extent ( 51.5 % for small volume hospitals , 44.3 % for large volume hospitals ; P < .0001 ) . CONCLUSION We observed a benefit to using endovascular procedures for RAAAs in institutions with significant endovascular experience ; however , the analysis of administrative data can not rule out selection bias as an explanation of better outcomes . These data strongly endorse the need for prospect i ve studies to clarify to what extent the improved survival in RAAA patients is to be attributed to the endovascular approach rather than the selection of low-risk patients OBJECTIVE To retrospectively compare a single center 's immediate and mid-term outcomes of ruptured abdominal aortic aneurysm open and endovascular repair ( EVAR ) for two patient groups-hemodynamically stable and unstable patients -in the same time period . METHODS Patients presenting at our center with confirmed rupture of an abdominal aortic aneurysm between December 1999 and April 2006 were considered according to an intention-to-treat model with EVAR . Patients with symptomatic or acute ( but not ruptured ) AAAs were not included in this study . Thirty-three patients underwent EVAR , and 91 underwent open repair . Seventy-two patients ( EVAR , 45 % ; open , 63 % ) were classified as hemodynamically unstable at arrival , and 52 were classified as stable ( EVAR , 55 % ; open , 37 % ) . Ninety-seven percent of EVAR procedures commenced under local anesthesia , and 100 % of open repairs occurred with general anesthesia . Overall successful graft deployment , 30-day mortality , overall reintervention rate , and complications were the study primary end points . RESULTS Overall successful graft deployment for EVAR was 91 % ; for open repair , it was 96 % . Overall 30-day mortality for EVAR was 30 % ( unstable , 53 % ; stable , 11 % ) , and the rate was 46 % for open repair ( unstable , 61 % ; stable , 21 % ) . The EVAR postoperative reintervention rate ( within 30 days ) was 15 % ( unstable , 20 % ; stable , 11 % ) , and for open repair it was 10 % ( unstable , 9 % ; stable , 15 % ) . We recorded a 27 % severe complication rate for EVAR patients 
    Output:
    
Endovascular aneurysm repair is not inferior to open repair in patients with a ruptured abdominal aortic aneurysm .