Ruptured Abdominal Aortic Aneurysm: Endovascular Repair is Feasible in 40% of Patients

Abstract

A total of 28% of patients with symptomatic or ruptured AAA was treated with EVAR. A potential 42% of patients could have been suitable for EVAR, if the correct devices had been in stock and all patients had been properly assessed.

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

“…CT angiography is widely recommended for assessing the feasibility of the endovascular procedure and for the measurement of vascular diameters when the patient is relatively stable and is able to tolerate CT examination (4,5). 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.…”

“…Despite significant improvements in critical care support, noninvasive diagnosis, anesthesia, and cardiosurgery over the last few decades, the conventional open surgical repair of an aortic rupture still carries a significant risk of serious complications and mortality (4)(5)(6). Perioperative mortality rates associated with the surgical repair of a ruptured abdominal aortic aneurysm (rAAA) or a thoracic aortic injury (TAI) ranges from 32% to 70% (5,(7)(8)(9).…”

“…Perioperative mortality rates associated with the surgical repair of a ruptured abdominal aortic aneurysm (rAAA) or a thoracic aortic injury (TAI) ranges from 32% to 70% (5,(7)(8)(9). Patients with rAAA and traumatic TAI are not frequently good surgical candidates because of old age, comorbidities, and concomitant multiple-system injuries, such as cranial injuries, multiple fractures, and pulmonary contusions.…”

“…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 most centers where endovascular treatment is available, the policy is to treat acute aortic injury patients with endovascular approach who are stable enough for CT angiography scanning (22). In most studies, the decision to treat patients with a rAAA or TAI is based on the hemodynamic situation of the patient at presentation to the hospital, anatomic considerations or logistic reasons, such as availability of adequate endovascular equipment and sufficiently trained staff (5,7,22). Optimal patient selection for EVAR requires a team including an interventional radiologist, vascular surgeon, emergency doctor, and anesthesiologist.…”