Dilemmas, challenges and current debates in approaching the rupture of an abdominal aortic aneurysm
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We aim to give a conceptual description of the differences between open and endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) which represents a significant problem due to the risk of rupture and its high death rates. Additionally, we underline and discuss the current debates referring to each approach.
The MEDLINE/PubMed database was searched for publications with the medical subject heading “Ruptured abdominal aortic aneurysms (RAAA)” and keywords “EVAR” or “open repair” or “eEVAR” or ” randomized controlled trials“. The search was conducted both on the basis of the MESH tree and as a text search. We restricted our search to English publications up to July 2010.
A total of 243 studies were identified, 78 of which were eventually deemed relevant to this review.
Patients who are suitable for this method are high-risk patients with suitable anatomy, and patients with suitable anatomy who expressed a preference for the method. The selection of patients for eEVAR is heavily debated, as far as factors like haemodynamic instability, imaging procedures, logistic issues and anatomical suitability are concerned. The “freer” the indications are for its application, the likelier the procedure is to present problems or failures which can lead to the process becoming challenged and restrained.
Key wordsAAA EVAR Open repair RAAA eEVAR Randomized Controlled trials
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- 3.Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005;365:2179–2186.Google Scholar
- 4.McPhee J, Eslami MH, Arous EJ, et al. Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001–2006): a significant survival benefit over open repair is independently associated with increased institutional volume. J Vasc Surg 2009;49:817–826.PubMedCrossRefGoogle Scholar
- 33.Nordon IM, Hinchliffe RJ, Holt PJ, et al. EVAR for ruptured AAAs — Do we need randomized controlled trials? J Cardiovasc Surg (Torino) 2009;50:617–625.Google Scholar
- 34.Reimerink JJ, Hoornweg LL, Vahl AC, et al. Controlled hypotension in patients suspected of a ruptured abdominal aortic aneurysm: feasibility during transport by ambulance services and possible harm. Eur J Vasc Endovasc Surg; 40:54–59.Google Scholar
- 39.Harris PL, Vallabhaneni SR, Desgranges P, et al. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg 2000;32:739–749.PubMedCrossRefGoogle Scholar
- 78.Mayer D, Rancic Z, Pfammatter T, et al. Choice of treatment for the patient with urgent AAA: practical tips. J Cardiovasc Surg (Torino) 2009;50:595–598Google Scholar