Endovascular graft repair of ruptured aortoiliac aneurysms11No competing interests declared.

Ohki, Takao; Veith, Frank J.; Sánchez, Luis A.; Cynamon, Jacob; Lipsitz, Evan C.; Wain, Reese A.; Morgan, J.A.; Zhen, Lu; Suggs, William D.; Lyon, Ross T.

doi:10.1016/s1072-7515(99)00051-4

Cited by 140 publications

(95 citation statements)

References 27 publications

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“…Of these, 7 articles were excluded because they were reviews or invited commentaries, 39,41,44,[48][49][50][51] 7 because they were series from the same institutions with duplicate clinical material, [36][37][38]40,42,45,46 1 because it was a study on octogenarians, 43 and 2 because they were single-case reports. 6,47 This left 29 studies for analysis, reporting on a total of 897 patients.…”

Section: Resultsmentioning

confidence: 99%

“…7,10 Since then, endovascular RAAA repair has evolved and become the preferred treatment option in many specialist centers. 10,14,19,30,32,43,47 Endovascular repair is appealing because patients often present in extremis and are elderly individuals with multiple comorbidities. An endovascular approach may avoid compounding the physiological stress of rupture with the surgical stresses of midline laparotomy, aortic cross-clamping, and the iatrogenic injuries that often occur during open repair.…”

Section: Commentmentioning

confidence: 99%

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Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Karkos

Harkin²,

Giannakou³

et al. 2009

Arch Surg

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Objective: To document mortality after endovascular repair of ruptured abdominal aortic aneurysms (RAAAs).Data Sources: MEDLINE and EMBASE databases.Study Selection: Articles that reported data on mortality after endovascular repair of RAAAs were identified. Only patients with true ruptures were included. Additionally, information on mortality after concurrent open repair was sought.Data Extraction: One of the authors reviewed all of the studies and extracted appropriate data. A total of 43 articles were identified, 14 of which were excluded.Data Synthesis: Twenty-nine articles with 897 patients who underwent endovascular repair met the inclusion criteria. Of the patients with available information, 86% were men; 29% had been operated on under local anesthesia; 28% were hemodynamically unstable; 17% required intra-aortic balloon occlusion; 48% received bifurcated stent grafts; 6% had endovascular procedures converted to open repair intraoperatively; and 5.5% developed abdominal compartment syndrome. Inhospital and/or 30-day mortality ranged between 0% and 54% in different series, whereas the pooled mortality after endovascular repair was 24.5% (95% confidence interval [CI], 19.8%-29.4%). In 19 studies reporting results of both endovascular and concurrent open repair from the same unit, the pooled mortality after open repair was 44.4% (95% CI, 40.0%-48.8%), and the pooled overall mortality for RAAA undergoing endovascular or open repair was 35% (95% CI, 30%-41%).Conclusions: Endovascular repair of RAAAs is associated with acceptable mortality rates. Additional studies will be required to verify these promising results and precisely define the role of endovascular treatment as an additional therapeutic option for RAAAs.

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Section: Resultsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

Karkos

Harkin²,

Giannakou³

et al. 2009

Arch Surg

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“…3) Much literature has demonstrated EVAR lowering overall in-hospital mortality compared with open repair in patients with ruptured AAA. [1][2][3][4] The mortality of EVAR and open repair for ruptured AAA during the same period was 24.5% and 44.4% respectively. 6) We consider that these data do not necessarily prove the superiority of EVAR in the treatment of ruptured AAA because there are patients with ruptured AAA who have anatomically unsuitable aneurysms for EVAR, and selection bias must exist in these data.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, many papers have reported that surgical outcomes for ruptured AAA were improved by emergency endovascular aortic repair (EVAR). [1][2][3][4] We have also performed emergency EVAR in limited patients with ruptured AAA since 2011. Regardless of the appropriate patient selection, there are patients in whom intraoperative conversion from emergency EVAR to open repair must be performed.…”

mentioning

confidence: 99%

Conversion to Open Repair from Emergency EVAR in a Patient with Ruptured AAA: Report of a Case

Ito

Koyanagi

Kawaharada

et al. 2012

Annals of Vascular Diseases

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A 77-year-old woman with a ruptured abdominal aortic aneurysm (AAA) was transferred to our hospital. Due to a severe comorbidity, endovascular aortic repair of the ruptured AAA was proposed. During the operation, although a Zenith ® AAA endovascular graft was deployed, digital subtracted angiography revealed an enhancement of the endoleak, and the patient became hemodynamically unstable. Therefore, we decided to convert to graft replacement of the abdominal aorta through a median laparotomy. During the postoperative period, the patient suffered from ischemic colitis, which resolved with conservative therapy. She was discharged after 33 postoperative days.

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“…36 The age of the patients ranged between 48 and 85 years, and the mean size of the aneurysms was 7.4 (range, 3-8) cm. Preoperative symptoms, which were present in each case, included abdominal or back pain (n=7), syncope (n=1), and external bleeding (n=1).…”

Section: Megs For Ruptured Aortoiliac Aneurysmsmentioning

confidence: 99%