Top

CardioVascular and Interventional Radiology

Published in:

01-05-2008 | Clinical Investigation

Endovascular Therapy of Ruptured Abdominal Aortic Aneurysm: Mid- and Long-Term Results

Authors: Klaus Kubin, Gottfried H. Sodeck, H. Teufelsbauer, Bernd Nowatschka, Georg Kretschmer, Johannes Lammer, Maria Schoder

Published in: CardioVascular and Interventional Radiology | Issue 3/2008

Abstract

As an alternative to open aneurysm repair, emergency endovascular aortic repair (EVAR) has emerged as a promising technique for ruptured abdominal aortic aneurysm (rAAA) within the last decade. The aim of this retrospective study is to present early and late outcomes of patients treated with EVAR for rAAA. Twenty-two patients (5 women, 17 men; mean age, 74 years) underwent EVAR for rAAA between November 2000 and April 2006. Diagnostic multislice computed tomography angiography was performed prior to stent-graft repair to evaluate anatomical characteristics and for follow-up examinations. Periprocedural patient characteristics and technical settings were evaluated. Mortality rates, hospital stay, and early and late complications, within a mean follow-up time of 744 ± 480 days, were also assessed. Eight of 22 patients were hemodynamically unstable at admission. Stent-graft insertion was successful in all patients. The total early complication rate was 54%, resulting in a 30-day mortality rate of 23%. The median intensive care unit stay was 2 days (range, 2–48 days), and the median hospital stay was 16 days (range, 9–210 days). During the follow-up period, three patients suffered from stent-graft-related complications. The overall mortality rate in our study group was 36%. EVAR is an acceptable, minimally invasive treatment option in patients with acute rAAA, independent of the patient’s general condition. Short- and long-term outcomes are definitely comparable to those with open surgical repair procedures.

Basnyat PS, Biffin AH, Moseley LG et al. (1999) Mortality from ruptured abdominal aortic aneurysm in Wales. Br J Surg 86:765–770PubMedCrossRef

Hechelhammer L, Lachat ML, Wildermuth S, et al (2005) Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 41:752–757PubMedCrossRef

Bown MJ, Sutton AJ, Bell PR, et al (2002) A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 89:714–730PubMedCrossRef

Ohki T, Veith FJ, Sanchez LA, et al (1999) Endovascular graft repair of ruptured aortoiliac aneurysms. J Am Coll Surg 189:102–112, discussion 112–103PubMedCrossRef

Lee WA, Hirneise CM, Tayyarah M, et al (2004) Impact of endovascular repair on early outcomes of ruptured abdominal aortic aneurysms. J Vasc Surg 40:211–215PubMedCrossRef

May J, White GH, Waugh R, et al (1999) Rupture of abdominal aortic aneurysms: a concurrent comparison of outcome of those occurring after endoluminal repair versus those occurring de novo. Eur J Vasc Endovasc Surg 18:344–348PubMedCrossRef

Mehta M, Darling RC III, Roddy SP et al. (2005) Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 42:1047–1051PubMedCrossRef

Ohki T, Veith FJ et al. (1999) Abdominal aortic aneurysms. Curr Treat Options Cardiovasc Med 1:19–26PubMedCrossRef

Tambyraja AL, Murie JA, Chalmers RT et al. (2005) Outcome and survival of patients aged 65 years and younger after abdominal aortic aneurysm rupture. World J Surg 29:1245–1247PubMedCrossRef

10.

Yilmaz N, Peppelenbosch N, Cuypers PW et al. (2002) Emergency treatment of symptomatic or ruptured abdominal aortic aneurysms: the role of endovascular repair. J Endovasc Ther 9:449–457PubMedCrossRef

11.

Yusuf SW, Whitaker SC, Chuter TA et al. (1994) Emergency endovascular repair of leaking aortic aneurysm. Lancet 344:1645PubMedCrossRef

12.

Hill BB, Wolf YG, Lee WA et al. (2002) Open versus endovascular AAA repair in patients who are morphological candidates for endovascular treatment. J Endovasc Ther 9:255–261PubMedCrossRef

13.

Peppelenbosch N, Yilmaz N, van Marrewijk C et al. (2003) Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Outcome of a prospective intent-to-treat by EVAR protocol. Eur J Vasc Endovasc Surg 26:303–310PubMedCrossRef

14.

Hinchliffe RJ, Braithwaite BD, Hopkinson BR et al. (2003) The endovascular management of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 25:191–201PubMedCrossRef

15.

Lachat M, Pfammatter T, Witzke H et al. (2002) Acute traumatic aortic rupture: early stent-graft repair. Eur J Cardiothorac Surg 21:959–963PubMedCrossRef

16.

Gandini R, Chiocchi M, Maresca L et al (2007) Chronic contained rupture of an abdominal aortic aneurysm: from diagnosis to endovascular resolution. CardioVasc Interv Radiol Epub 21 August 2007

17.

Clevert DA, Stickel M, Flach P et al. (2007) Contrast-enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment. CardioVasc Interv Radiol 30:480–484CrossRef

18.

Lloyd GM, Bown MJ, Norwood MG et al. (2004) Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: a time-to-death study in patients without operation. J Vasc Surg 39:788–791PubMedCrossRef

19.

Mehta M, Taggert J, Darling RC III et al. (2006) Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 44:1–8PubMedCrossRef

20.

Van Herzeele I, Vermassen F, Durieux C et al. (2003) Endovascular repair of aortic rupture. Eur J Vasc Endovasc Surg 26:311–316PubMedCrossRef

21.

Coppi G, Silingardi R, Gennai S et al. (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44:1140–1147PubMedCrossRef

22.

Hinchliffe RJ, Yusuf SW, Macierewicz JA et al. (2001) Endovascular repair of ruptured abdominal aortic aneurysm—a challenge to open repair? Results of a single centre experience in 20 patients. Eur J Vasc Endovasc Surg 22:528–534PubMedCrossRef

23.

Armon MP, Yusuf SW, Whitaker SC et al. (1997) The anatomy of abdominal aortic aneurysms: implications for sizing of endovascular grafts. Eur J Vasc Endovasc Surg 13:398–402PubMedCrossRef

24.

Henretta JP, Hodgson KJ, Mattos MA et al. (1999) Feasibility of endovascular repair of abdominal aortic aneurysms with local anesthesia with intravenous sedation. J Vasc Surg 29:793–798PubMedCrossRef

25.

Peppelenbosch N, Geelkerken RH, Soong C et al. (2006) Endograft treatment of ruptured abdominal aortic aneurysms using the Talent aortouniiliac system: an international multicenter study. J Vasc Surg 43:1111–1123, discussion 1123PubMedCrossRef

26.

Gloviczki P, Pairolero PC, Mucha P Jr et al. (1992) Ruptured abdominal aortic aneurysms: repair should not be denied. J Vasc Surg 15:851–857, discussion 857–859PubMedCrossRef

27.

Hartung O, Vidal V, Marani I et al. (2007) Treatment of an early type II endoleak causing hemorrhage after endovascular aneurysm repair for ruptured abdominal aortic aneurysm. J Vasc Surg 45:1062–1065PubMedCrossRef

28.

Hunter JD, Damani Z et al. (2004) Intra-abdominal hypertension and the abdominal compartment syndrome. Anaesthesia 59:899–907PubMedCrossRef

29.

Orend KH, Kotsis T, Scharrer-Pamler R et al. (2002) Endovascular repair of aortic rupture due to trauma and aneurysm. Eur J Vasc Endovasc Surg 23:61–67PubMedCrossRef

30.

Resch T, Malina M, Lindblad B et al. (2003) Endovascular repair of ruptured abdominal aortic aneurysms: logistics and short-term results. J Endovasc Ther 10:440–446PubMedCrossRef

31.

Reichart M, Geelkerken RH, Huisman AB et al. (2003) Ruptured abdominal aortic aneurysm: endovascular repair is feasible in 40% of patients. Eur J Vasc Endovasc Surg 26:479–486PubMedCrossRef

32.

Resch T, Koul B, Dias NV et al. (2001) Changes in aneurysm morphology and stent-graft configuration after endovascular repair of aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 122:47–52PubMedCrossRef

Title: Endovascular Therapy of Ruptured Abdominal Aortic Aneurysm: Mid- and Long-Term Results
Authors: Klaus Kubin
Gottfried H. Sodeck
H. Teufelsbauer
Bernd Nowatschka
Georg Kretschmer
Johannes Lammer
Maria Schoder
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 3/2008
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-007-9253-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Endovascular Therapy of Ruptured Abdominal Aortic Aneurysm: Mid- and Long-Term Results

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2008

Is Internal Iliac Artery Embolization Essential Prior to Endovascular Repair of Aortoiliac Aneurysms?

Endovascular Management of Acute Bleeding Arterioenteric Fistulas

Comparison of Patient Dose in Two-Dimensional Carotid Arteriography and Three-Dimensional Rotational Angiography

Embolization of an Insulinoma of the Pancreas with Trisacryl Gelatin Microspheres as Definitive Treatment

A Technical Tip to Aid Successful Placement of a Colonic Stent

Measurement of Pleural Temperature During Radiofrequency Ablation of Lung Tumors to Investigate Its Relationship to Occurrence of Pneumothorax or Pleural Effusion