Emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysms: an institutional experience

Abstract

Objectives: Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still under investigation. Since installation of an urgent eEVAR kit in our hospital, all patients with a rAAA or urgent thoracic aortic aneurysm are candidates for eEVAR or eTEVAR (emergency thoracic evar), respectively. For this study, we analyzed all rAAA patients treated with eEVAR.Methods: Data were recorded prospectively. Criteria for an eEVAR were an infrarenal neck > 15mm, acceptable landing zone, angles below 70° and a good femoral approach. We prefer preoperative angio CT-scan but in case of instability, an intra-aortic balloon can stabilize the patient during angiography (in the OR) to decide between open or eEVAR repair. Follow-up was performed on regular intervals by duplex or CT-scan. Thirty-day mortality and overall survival were calculated.Results: Since 2006, nine male rAAA patients with a mean age of 73 years (range: 62–82) had eEVAR repair. Aneurysm diameter was 8 cm (range: 5.8–11). The Hardman index was 1.5 (range: 0–3). In eight patients an aorto-uni-iliac device was placed succesfully followed by a femorofemoral crossover bypass. The 30-day operative mortality was 12.5% (one patient with septic shock). Three patients showed a type 2 endoleak with stable diameter during follow-up but one patient showed expansion 4 years after treatment.Conclusions: Treating rAAA with eEVAR in selected patients with acceptable anatomy and a kit permanently available in the operating room yielded good results by a surgical team trained for both open and eEVAR repair. The conversion rate was low (11%) and the survival (immediate and 30-days) was excellent (87.5%).