Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Outcome of a prospective intent-to-treat by EVAR protocol

Abstract

e-EVAR was a feasible treatment in the majority of patients with rAAA and snrAAA. Blood loss and the requirements of fluid transfusion were significantly decreased. Most importantly in this institutional series significantly lower first-month mortality was observed in the group with preferential e-EVAR compared to a control group. A multi-center study assessing the outcome of preferential use of e-EVAR in patients with acute symptomatic AAA is required.

Endovascular repair of thoracic and abdominal aortic ruptures: a single-center experience

“…Several case reports and case series evaluating the technical feasibility and safety of endovascular treatment for rAAA and TAI suggest that between 40% and 80% of rAAAs are suitable for endovascular aortic repair (EVAR) (5,7,13,14), and the perioperative mortality rates for endovascular repair of rAAA and TAI are 10%-29% (15)(16)(17) and 0%-20% (10,11,18), respectively.…”

“…In our study we did not have to use additional stent-graft segments due to the exact sizing of the stent-grafts according to CT angiography measurements, except in one procedure in which an inadequate deployment occurred. The operating room can be prepared for an emergency procedure during the time needed to perform and evaluate the CT angiography (14,16), and this approach was followed in the present study. One study suggests that intraoperative calibrated angiography should be used instead of CT angiography for patients who are in profound shock (7); however, the rupture site can be missed by DSA because of its limited two dimensional imaging capability.…”

“…We used bifurcated devices to achieve a more anatomic reconstruction of rAAAs, although AUI systems have been advocated for the management of emergency cases (14,16). An AUI device generally enables more rapid exclusion of the aneurysm, and the bleeding and the pressure in the aneurysmal sac can be rapidly controlled.…”

“…Our patient had the risk factors of extensive graft coverage below T6 and perioperative hypotension. Management strategies (11,12,14), respectively. These mortality rates are lower than the 30-day mortality rates of conventional open surgical repair of the aorta, which are up to 41% and 45% for EVAR and TEVAR, respectively (4-6).…”

Management and endovascular treatment of symptomatic abdominal aortic aneurysms

“…Dissections and traumatic lesions of the abdominal aorta are rare [1]. Although significant progress has been made in the fields of diagnosis, surgery and anaesthesiology, mortality among patients with AAA rupture who arrive at the hospital alive is 45%-70% [2]. Since 1990, the year of the first aortic stentgraft implanted by Parodi, an alternative treatment, which is less invasive especially for patients at high surgical risk, has emerged [3].…”