Management of ruptured abdominal aortic aneurysm in the endovascular era

Abstract

Use of an algorithm favoring endovascular repair resulted in a highly significant reduction in rAAA mortality in our urban hospital. Thirty-day mortality for open repair was no different between pre- and post-protocol eras. With modern techniques of resuscitation and surgical management, a majority of patients presenting with rAAA can survive.

Efficacy of endovascular management approach of ruptured abdominal aortic aneurysm

“…There is still some suggestive evidence that during the postoperative period (30 days), the results of the endovascular approach (Evar) ruptured AAA can be better than open repair of AAA. 32,33,35,[76][77][78][79] As a result, in cases where there are multiple risk factors and a poor prognosis with regard to the open technique, as well as a proper anatomy for the endovascular procedure, we suggest an attempt to EVAR, since the hospital service has experienced staff and appropriate equipment available.…”

Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

“…Many institutions that have adopted the rEVAR first approach have seen significant benefits. Of the single-center experience observational studies, the most recent report by Starnes et al comparing outcomes before and after implementation of a rEVARfirst protocol, showed that their overall 30-day mortality fell from 54.2% to 18.5% (Starnes et al, 2009). On a larger scale, outcomes of implementing a rEVAR first protocol was reviewed in a large co-operative multicenter cohort study by Veith et al in 2009 spanning 49 institutions in 13 countries.…”

Ruptured Thoracic Aneurysms

“…18 A multicenter nonrandomized clinical trial of the GORE TAG device for treating thoracic aortic catastrophes (dissections, ruptures, and traumatic tears) showed a combined 30-day death/paraplegia rate of 13.6%; in contrast, a composite literature control group of Ͼ800 patients had a combined death/paraplegia rate of 29.6%. 19 When Patel and coworkers 20 compared standard open DTAA repair with TEVAR for treating ruptured thoracic aneurysms, they found that TEVAR resulted in lower morbidity and mortality; moreover, this approach provided equivalent late outcomes even in an older group typically considered at high risk for open repair.…”

“…Although the current use of TEVAR for ruptured thoracic aneurysms remains off label, the success demonstrated by Jonker and colleagues and by several others establishes a strong foundation that would support the use of TEVAR as the primary modality for treating ruptured DTAAs in the near future. 3,14,17,18 It is crucial that major hospitals and emergency departments be equipped with stringent protocols that will allow rapid triage of these patients and expedite the imaging work-up, thereby ensuring better outcomes. …”