<b>Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms:</b>A Shift of the Paradigm?

Larzon, Thomas; Lindgren, Rikard; Norgren, Lars

doi:10.1583/04-1469.1

Cited by 105 publications

(79 citation statements)

References 21 publications

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“…The use of EVAR for abdominal aortic aneurysm offers the potential advantage of avoiding the complications associated with a large abdominal surgical incision, avoiding the stress on organs and tissues induced by the need to cross clamp the aorta, decreasing bleeding and inflammatory response from surgical tissue dissection, reducing risk of multiorgan failure, lessening the requirement for deep anesthesia, and providing a repair mechanism for patients who are too high risk for open repair surgical procedures due to cardiac risk factors or other comorbidity [1,[5][6][7][8][9][11][12][13]. Endovascular aneurysm repair also offers the benefit of shorter hospital stays, reduced recovery time, less post-procedural pain, and avoids the complication of adhesive intestinal obstruction when compared to open repair [1,[4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular aneurysm repair also offers the benefit of shorter hospital stays, reduced recovery time, less post-procedural pain, and avoids the complication of adhesive intestinal obstruction when compared to open repair [1,[4][5][6][7][8][9]. However, a negative aspect for EVAR is the possibility of graft movement after treatment that could allow reinstatement of the aneurysm [1,4,10,13].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, EVAR is associated with the development of endoleaks, which require repair. Both of these potential complications require lifelong surveillance [1,4,[6][7]10,13].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In patients with ruptured AAA, EVAR appears to offer a decreased operative mortality [1,[5][6][7][8][9][10]. Unfortunately, this information is derived from retrospective studies or case series with little randomized prospective data available, and the available studies may not adequately adjust for selection bias [4,[6][7][8][9][10]14,15]. There is a tendency for more severely unstable patients requiring a faster treatment decision to undergo traditional open repair, and because circulatory shock is a significant prognostic factor, this has been suggested to falsely improve the favorable EVAR results [1,2,4,[6][7][8][9][10][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

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Successful use of emergent endovascular aneurysm repair for a ruptured hypotensive abdominal aortic aneurysm

Basile¹,

Fiesseler²,

Shih³

2013

CRCM

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CASE REPORTA 66-year-old man presented to an emergency department with acute abdominal pain. The pain started abruptly and was severe in nature starting several hours before. Just prior to ED arrival, the patient had a brief syncopal episode lasting 1 -2 minutes. He complained of nausea but denied difficulty breathing, chest pain or recent illness. He had a past medical history significant for a myocardial infarction, hypercholesterolemia and hypertension. He denied smoking. His initial vital signs were temperature, 36.4˚C; heart rate, 101 beats per minute; respiratory rate, 18 per minute; and blood pressure, 97/56 mmHg. On physical examination, he appeared pale and in distress. His chest and cardiac examination were unremarkable. His abdomen was protuberant with marked diffuse tenderness and a pulsatile abdominal mass. A bedside ultrasound was immediately obtained that demonstrated a large AAA. Initial laboratory tests revealed a white blood cell count of 19.08 H/nL, hemoglobin of 13.3 g/dL, a creatinine of 1.3 mg/dL, and a troponin-I of 0.099 ng/mL. The remainder of the initial laboratory tests was unremarkable. Shortly after ED arrival the patient's systolic blood pressure decreased to 60 mmHg. With intravenous fluids the systolic blood pressure rose into the 70 -80 mmHg range. The patient remained awake and oriented with these blood pressures.The initial diagnosis was a hemodynamically unstable ruptured abdominal aortic aneurysm in need of acute surgical repair with a high mortality risk. The patient was considered for endovascular aneurysm repair and underwent an emergency CT scan of the abdomen and pelvis to assess eligibility for this procedure. Despite having a blood pressure that was in the 70 -80 mmHg range, the patient remained awake and alert. The patient was accompanied by the vascular surgery team to radiology while the CT scan was performed. The pre-radiology plan was if the patient decompensated during the performance of the CT scan, the vascular team would discontinue the CT scan and immediately take the patient for emergency open operative repair of the AAA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In addition, EVAR is associated with the development of endoleaks, which require repair. Both of these potential complications require lifelong surveillance [1,4,[6][7]10,13].…”

Section: Discussionmentioning

confidence: 99%