{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:44:58Z","timestamp":1777941898328,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Endovascular Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of introducing a surgeon-led emergency endovascular aneurysm repair (EVAR) service on patient outcomes and cost efficiency in the management of ruptured abdominal aortic aneurysms (rAAA) at a UK tertiary vascular center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study was conducted, including all patients presenting with rAAA between January 2019 and December 2023. Patients were categorized into two time periods: before (\n                      <jats:bold>Period A<\/jats:bold>\n                      : 2019-2020) and after (\n                      <jats:bold>Period B<\/jats:bold>\n                      : 2021-2023) the introduction of the emergency EVAR service. Outcomes assessed included 30-day and one-year mortality, length of hospital stay, complication rates, and return-to-theatre rates. Cost-effectiveness analysis was conducted using incremental cost-effectiveness ratio (ICER) calculations based on Quality-Adjusted Life Years (QALYs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 71 patients with ruptured abdominal aortic aneurysm were identified, of whom 58 underwent surgical repair (OSR or EVAR). In Period A, all patients (n = 17) underwent open surgical repair. In Period B, 24 received OSR (58.5%) and 17 received EVAR (41.5%). The 30-day mortality rate was significantly lower in the EVAR group (5.9%) compared to OSR in both periods (63.3% and 50%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001). The one-year mortality rate remained unchanged for EVAR but increased for OSR (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .00075). Return-to-theatre rates were significantly higher in OSR patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .044). ICER calculations showed EVAR to be cost-effective (\u2212\u00a3202\u00a0526 per QALY within one year).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The introduction of a surgeon-led emergency EVAR service significantly improved early survival rates and reduced reintervention rates in rAAA patients while demonstrating cost-effectiveness compared to OSR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15385744251375278","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T17:28:15Z","timestamp":1756402095000},"page":"5-11","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Introducing a Surgeon-Led Emergency EVAR Service on Outcomes and Cost Efficiency in Ruptured Aortic Aneurysm Management: A UK Single-Center Experience"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4946-5998","authenticated-orcid":false,"given":"Ahmed","family":"Hassan","sequence":"first","affiliation":[{"name":"UHCW-NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Elshiekh","sequence":"additional","affiliation":[{"name":"UHCW-NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Matharu","sequence":"additional","affiliation":[{"name":"UHCW-NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Sergiou","sequence":"additional","affiliation":[{"name":"UHCW-NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashraf","family":"Elsharkawy","sequence":"additional","affiliation":[{"name":"UHCW-NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asif","family":"Mahmood","sequence":"additional","affiliation":[{"name":"UHCW-NHS"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.09.020"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0909305"},{"issue":"1","key":"e_1_3_4_4_2","first-page":"1","article-title":"EVAR for rupture: more evidence for preferential use","volume":"39","author":"Veith FJ","year":"2010","unstructured":"Veith FJ, Lachat M, Mayer D, et al. EVAR for rupture: more evidence for preferential use. Eur J Vasc Endovasc Surg. 2010;39(1):1-3.","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"e_1_3_4_5_2","first-page":"f7661","article-title":"Endovascular strategy vs. OSR for rAAA","volume":"348","author":"IMPROVE Trial Investigators","year":"2014","unstructured":"IMPROVE Trial Investigators. Endovascular strategy vs. OSR for rAAA. BMJ. 2014;348:f7661.","journal-title":"BMJ"},{"issue":"1","key":"e_1_3_4_6_2","first-page":"20","article-title":"The role of EVAR in emergency AAA repair","volume":"57","author":"Mayer D","year":"2013","unstructured":"Mayer D, Veith FJ, Lachat M, et al. The role of EVAR in emergency AAA repair. J Vasc Surg. 2013;57(1):20-25.","journal-title":"J Vasc Surg"},{"issue":"2","key":"e_1_3_4_7_2","first-page":"409","article-title":"EVAR vs. OSR: outcomes in emergency AAA treatment","volume":"261","author":"Mehta M","year":"2015","unstructured":"Mehta M, Byrne J, Darling RC, et al. EVAR vs. OSR: outcomes in emergency AAA treatment. Ann Surg. 2015;261(2):409-416.","journal-title":"Ann Surg"},{"issue":"1","key":"e_1_3_4_8_2","first-page":"75","article-title":"One-year outcomes of endovascular vs. open repair in rAAA","volume":"54","author":"IMPROVE Trial Investigators","year":"2017","unstructured":"IMPROVE Trial Investigators. One-year outcomes of endovascular vs. open repair in rAAA. Eur J Vasc Endovasc Surg. 2017;54(1):75-81.","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"10058","key":"e_1_3_4_9_2","first-page":"2366","article-title":"Long-term outcomes of EVAR vs. OSR for rAAA","volume":"388","author":"Powell JT","year":"2016","unstructured":"Powell JT, Sweeting MJ, Brown LC, et al. Long-term outcomes of EVAR vs. OSR for rAAA. Lancet. 2016;388(10058):2366-2374.","journal-title":"Lancet"},{"issue":"7","key":"e_1_3_4_10_2","first-page":"863","article-title":"Mortality trends in rAAA repair","volume":"100","author":"Karthikesalingam A","year":"2013","unstructured":"Karthikesalingam A, Hinchliffe RJ, Poloniecki JD, et al. Mortality trends in rAAA repair. Br J Surg. 2013;100(7):863-871.","journal-title":"Br J Surg"},{"issue":"10029","key":"e_1_3_4_11_2","first-page":"957","article-title":"Long-term comparison of EVAR vs. OSR for rAAA","volume":"387","author":"Patel R","year":"2016","unstructured":"Patel R, Sweeting MJ, Powell JT, et al. Long-term comparison of EVAR vs. OSR for rAAA. Lancet. 2016;387(10029):957-964.","journal-title":"Lancet"},{"issue":"5","key":"e_1_3_4_12_2","first-page":"577","article-title":"Meta-analysis of EVAR vs. OSR for ruptured AAA","volume":"39","author":"Jongkind V","year":"2010","unstructured":"Jongkind V, Yeung KK, Akkersdijk GJ, et al. Meta-analysis of EVAR vs. OSR for ruptured AAA. Eur J Vasc Endovasc Surg. 2010;39(5):577-589.","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"2","key":"e_1_3_4_13_2","first-page":"199","article-title":"Cost-effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm based on the IMPROVE trial","volume":"105","author":"Patel R","year":"2018","unstructured":"Patel R, Sweeting MJ, Powell JT, et al. Cost-effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm based on the IMPROVE trial. Br J Surg. 2018;105(2):199-208.","journal-title":"Br J Surg"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.10.044"},{"key":"e_1_3_4_15_2","volume-title":"2023 Annual Report","author":"National Vascular Registry","year":"2023","unstructured":"National Vascular Registry. 2023 Annual Report. London: The Royal College of Surgeons of England; 2023. 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