Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms

Abstract

Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature.

Clinical outcomes for endovascular repair of abdominal aortic aneurysm with the Seal stent graft

“…The role and efficacy of EVAR for ruptured AAA has not been established clearly. 19,20 In this context, the technical and clinical success rates for EVAR in the 13 cases of ruptured AAA seem to be good, despite including four contained ruptured AAAs. The nine cases of ruptured AAA exhibited a state of hypovolemic shock at their admission to each center's emergency department, and underwent emergent EVAR with a concomitant blood transfusion of greater than 10 packs.…”