Hellenic Journal of Surgery

, Volume 84, Issue 6, pp 381–389 | Cite as

Dilemmas, challenges and current debates in approaching the rupture of an abdominal aortic aneurysm

Review Article
  • 37 Downloads

Abstract

Aim-Background

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.

Methods

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.

Results

A total of 243 studies were identified, 78 of which were eventually deemed relevant to this review.

Conclusions

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 words

AAA EVAR Open repair RAAA eEVAR Randomized Controlled trials 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491–499.PubMedCrossRefGoogle Scholar
  2. 2.
    Creech O, Jr. Endo-aneurysmorrhaphy and treatment of aortic aneurysm. Ann Surg 1966;164:935–946.PubMedCrossRefGoogle Scholar
  3. 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. 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
  5. 5.
    Lesperance K, Andersen C, Singh N, et al. Expanding use of emergency endovascular repair for ruptured abdominal aortic aneurysms: disparities in outcomes from a nationwide perspective. J Vasc Surg 2008;47:1165–1170; discussion 1170-1161.PubMedCrossRefGoogle Scholar
  6. 6.
    Bown MJ, Sutton AJ, Bell PR, Sayers RD. A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 2002;89:714–730.PubMedCrossRefGoogle Scholar
  7. 7.
    Mehta M. Endovascular aneurysm repair for ruptured abdominal aortic aneurysm: How I do it. J Vasc Surg. 2010;52(6):1706–1712.PubMedCrossRefGoogle Scholar
  8. 8.
    Davenport DL, O’Keeffe SD, Minion DJ, et al. Thirty-day NSQIP database outcomes of open versus endoluminal repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2010;51:305–309 e301.PubMedCrossRefGoogle Scholar
  9. 9.
    Hinchliffe RJ, Yusuf SW, Macierewicz JA, et al. 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 2001;22:528–534.PubMedCrossRefGoogle Scholar
  10. 10.
    Cota AM, Omer AA, Jaipersad AS, Wilson NV. Elective versus ruptured abdominal aortic aneurysm repair: a 1-year cost-effectiveness analysis. Ann Vasc Surg 2005;19:858–861.PubMedCrossRefGoogle Scholar
  11. 11.
    Hayter CL, Bradshaw SR, Allen RJ, et al. Follow-up costs increase the cost disparity between endovascular and open abdominal aortic aneurysm repair. J Vasc Surg 2005;42:912–918.PubMedCrossRefGoogle Scholar
  12. 12.
    Mehta M, Taggert J, Darling RC, 3rd, et al. Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 2006;44:1–8; discussion 8.PubMedCrossRefGoogle Scholar
  13. 13.
    Sandford RM, Bown MJ, Fishwick G, et al. Duplex ultrasound scanning is reliable in the detection of endoleak following endovascular aneurysm repair. Eur J Vasc Endovasc Surg 2006;32:537–541.PubMedCrossRefGoogle Scholar
  14. 14.
    Zannetti S, De Rango P, Parente B, et al. Role of duplex scan in endoleak detection after endoluminal abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2000;19:531–535.PubMedCrossRefGoogle Scholar
  15. 15.
    Cho JS, Park T, Kim JY, et al. Prior endovascular abdominal aortic aneurysm repair provides no survival benefits when the aneurysm ruptures. J Vasc Surg. 2010;52(5):1127–34PubMedCrossRefGoogle Scholar
  16. 16.
    Wolf YG, Johnson BL, Hill BB, et al. Duplex ultrasound scanning versus computed tomographic angiography for postoperative evaluation of endovascular abdominal aortic aneurysm repair. J Vasc Surg 2000;32:1142–1148.PubMedCrossRefGoogle Scholar
  17. 17.
    Peppelenbosch N, Buth J, Harris PL, et al. Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: does size matter? A report from EUROSTAR. J Vasc Surg 2004;39:288–297.PubMedCrossRefGoogle Scholar
  18. 18.
    Coppi G, Gennai S, Saitta G, et al. Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment. J Vasc Surg 2009;49:582–588.PubMedCrossRefGoogle Scholar
  19. 19.
    Schlosser FJ, Gusberg RJ, Dardik A, et al. Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur J Vasc Endovasc Surg 2009;37:15–22.PubMedCrossRefGoogle Scholar
  20. 20.
    Zarins CK, Crabtree T, Bloch DA, et al. Endovascular aneurysm repair at 5 years: Does aneurysm diameter predict outcome? J Vasc Surg 2006;44:920–929; discussion 929–931.PubMedCrossRefGoogle Scholar
  21. 21.
    Hoornweg LL, Storm-Versloot MN, Ubbink DT, et al. Meta analysis on mortality of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2008;35:558–570.PubMedCrossRefGoogle Scholar
  22. 22.
    Richards T, Goode SD, Hinchliffe R, et al. The importance of anatomical suitability and fitness for the outcome of endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2009;38:285–290.PubMedCrossRefGoogle Scholar
  23. 23.
    Timaran CH, Rosero EB, Smith ST, et al. Influence of age, aneurysm size, and patient fitness on suitability for endovascular aortic aneurysm repair. Ann Vasc Surg 2008;22:730–735.PubMedCrossRefGoogle Scholar
  24. 24.
    Hoornweg LL, Wisselink W, Vahl A, Balm R. The Amsterdam Acute Aneurysm Trial: suitability and application rate for endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2007;33:679–683.PubMedCrossRefGoogle Scholar
  25. 25.
    Alsac JM, Desgranges P, Kobeiter H, Becquemin JP. Emergency endovascular repair for ruptured abdominal aortic aneurysms: feasibility and comparison of early results with conventional open repair. Eur J Vasc Endovasc Surg 2005;30:632–639.PubMedCrossRefGoogle Scholar
  26. 26.
    Cho JS, Dillavou ED, Rhee RY, Makaroun MS. Late abdominal aortic aneurysm enlargement after endovascular repair with the Excluder device. J Vasc Surg 2004;39:1236–1241; discussion 2141–1232.PubMedCrossRefGoogle Scholar
  27. 27.
    Fransen GA, Vallabhaneni SR, Sr., van Marrewijk CJ, et al. Rupture of infra-renal aortic aneurysm after endovascular repair: a series from EUROSTAR registry. Eur J Vasc Endovasc Surg 2003;26:487–493.PubMedCrossRefGoogle Scholar
  28. 28.
    Buth J, van Marrewijk CJ, Harris PL, et al. Outcome of endovascular abdominal aortic aneurysm repair in patients with conditions considered unfit for an open procedure: a report on the EUROSTAR experience. J Vasc Surg 2002;35:211–221.PubMedCrossRefGoogle Scholar
  29. 29.
    Hinchliffe RJ, Braithwaite BD, Hopkinson BR. The endovascular management of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2003;25:191–201.PubMedCrossRefGoogle Scholar
  30. 30.
    Veith FJ, Gargiulo NJ, 3rd, Ohki T. Endovascular treatment of ruptured infrarenal aortic and iliac aneurysms. Acta Chir Belg 2003;103:555–562.PubMedGoogle Scholar
  31. 31.
    Dalainas I, Nano G, Bianchi P, et al. Endovascular techniques for the treatment of ruptured abdominal aortic aneurysms: 7-year intention-to-treat results. World J Surg 2006;30:1809–1814; discussion 1815–1806.PubMedCrossRefGoogle Scholar
  32. 32.
    Brandt M, Walluscheck KP, Jahnke T, et al. Endovascular repair of ruptured abdominal aortic aneurysm: feasibility and impact on early outcome. J Vasc Interv Radiol 2005;16:1309–1312.PubMedCrossRefGoogle Scholar
  33. 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. 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
  35. 35.
    Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004;364:843–848.PubMedCrossRefGoogle Scholar
  36. 36.
    Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351:1607–1618.PubMedCrossRefGoogle Scholar
  37. 37.
    Schermerhorn ML, O’Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 2008;358:464–474.PubMedCrossRefGoogle Scholar
  38. 38.
    Szmidt J, Galazka Z, Rowinski O, et al. Late aneurysm rupture after endovascular abdominal aneurysm repair. Interact Cardiovasc Thorac Surg 2007;6:490–494.PubMedCrossRefGoogle Scholar
  39. 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
  40. 40.
    Cuypers PW, Laheij RJ, Buth J. Which factors increase the risk of conversion to open surgery following endovascular abdominal aortic aneurysm repair? The EUROSTAR collaborators. Eur J Vasc Endovasc Surg 2000;20:183–189.PubMedCrossRefGoogle Scholar
  41. 41.
    Franks SC, Sutton AJ, Bown MJ, Sayers RD. Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2007;33:154–171.PubMedCrossRefGoogle Scholar
  42. 42.
    Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007;116:2544–2552.PubMedCrossRefGoogle Scholar
  43. 43.
    van Marrewijk CJ, Fransen G, Laheij RJ, et al. Is a type II endoleak after EVAR a harbinger of risk? Causes and outcome of open conversion and aneurysm rupture during follow-up. Eur J Vasc Endovasc Surg 2004;27:128–137.PubMedCrossRefGoogle Scholar
  44. 44.
    Jones JE, Atkins MD, Brewster DC, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg 2007;46:1–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Jonker FH, Schlosser FJ, Dewan M, et al. Abdominal aortic aneurysm repair in obese patients: improved outcome after endovascular treatment compared with open surgery. Vasc Endovascular Surg 2010;44:105–109.PubMedCrossRefGoogle Scholar
  46. 46.
    Jonker FH, Schlosser FJ, Dewan M, et al. Patients with abdominal aortic aneurysm and chronic obstructive pulmonary disease have improved outcomes with endovascular aneurysm repair compared with open repair. Vascular 2009;17:316–324.PubMedCrossRefGoogle Scholar
  47. 47.
    Sadat U, Boyle JR, Walsh SR, et al. Endovascular vs open repair of acute abdominal aortic aneurysms—a systematic review and meta-analysis. J Vasc Surg 2008;48:227–236.PubMedCrossRefGoogle Scholar
  48. 48.
    Chaar CI, Fitzgerald TN, Dewan M, et al. Endovascular aneurysm repair is associated with less malnutrition than open abdominal aortic aneurysm repair. Am J Surg 2009;198:623–627.PubMedCrossRefGoogle Scholar
  49. 49.
    Arya N, Makar RR, Lau LL, et al. An intention-to-treat by endovascular repair policy may reduce overall mortality in ruptured abdominal aortic aneurysm. J Vasc Surg 2006;44:467–471.PubMedCrossRefGoogle Scholar
  50. 50.
    Egorova N, Giacovelli J, Greco G, et al. National outcomes for the treatment of ruptured abdominal aortic aneurysm: comparison of open versus endovascular repairs. J Vasc Surg 2008;48:1092–1100, 1100 e1091-1092.PubMedCrossRefGoogle Scholar
  51. 51.
    Lee RW, Rhodes JM, Singh MJ, et al. Is there a selection bias in applying endovascular aneurysm repair for rupture? Ann Vasc Surg 2008;22:215–220.PubMedCrossRefGoogle Scholar
  52. 52.
    Baxendale BR, Baker DM, Hutchinson A, et al. Haemodynamic and metabolic response to endovascular repair of infrarenal aortic aneurysms. Br J Anaesth 1996;77:581–585.PubMedCrossRefGoogle Scholar
  53. 53.
    Boyle JR, Goodall S, Thompson JP, et al. Endovascular AAA repair attenuates the inflammatory and renal responses associated with conventional surgery. J Endovasc Ther 2000;7:359–371.PubMedCrossRefGoogle Scholar
  54. 54.
    Greco G, Egorova N, Anderson PL, et al. Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms. J Vasc Surg 2006;43:453–459.PubMedCrossRefGoogle Scholar
  55. 55.
    Vaddineni SK, Russo GC, Patterson MA, et al. Ruptured abdominal aortic aneurysm: a retrospective assessment of open versus endovascular repair. Ann Vasc Surg 2005;19:782–786.PubMedCrossRefGoogle Scholar
  56. 56.
    Yilmaz N, Peppelenbosch N, Cuypers PW, et al. Emergency treatment of symptomatic or ruptured abdominal aortic aneurysms: the role of endovascular repair. J Endovasc Ther 2002;9:449–457.PubMedCrossRefGoogle Scholar
  57. 57.
    Rao SV, Jollis JG, Harrington RA, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. Jama 2004;292:1555–1562.PubMedCrossRefGoogle Scholar
  58. 58.
    Jani SM, Smith DE, Share D, et al. Blood transfusion and inhospital outcomes in anemic patients with myocardial infarction undergoing percutaneous coronary intervention. Clin Cardiol 2007;30:II49–56.PubMedCrossRefGoogle Scholar
  59. 59.
    Leal-Noval SR, Rincon-Ferrari MD, Garcia-Curiel A, et al. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 2001;119:1461–1468.PubMedCrossRefGoogle Scholar
  60. 60.
    Chelemer SB, Prato BS, Cox PM, Jr., et al. Association of bacterial infection and red blood cell transfusion after coronary artery bypass surgery. Ann Thorac Surg 2002;73:138–142.PubMedCrossRefGoogle Scholar
  61. 61.
    Engoren MC, Habib RH, Zacharias A, et al. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002;74:1180–1186.PubMedCrossRefGoogle Scholar
  62. 62.
    Henderson WG, Khuri SF, Mosca C, et al. Comparison of riskadjusted 30-day postoperative mortality and morbidity in Department of Veterans Affairs hospitals and selected university medical centers: general surgical operations in men. J Am Coll Surg 2007;204:1103–1114.PubMedCrossRefGoogle Scholar
  63. 63.
    Johnson RG, Arozullah AM, Neumayer L, et al. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204:1188–1198.PubMedCrossRefGoogle Scholar
  64. 64.
    Coscas R, Greenberg RK, Mastracci TM, et al. Associated factors, timing, and technical aspects of late failure following open surgical aneurysm repairs. J Vasc Surg 2010;52:272–281.PubMedCrossRefGoogle Scholar
  65. 65.
    Litwinski RA, Donayre CE, Chow SL, et al. The role of aortic neck dilation and elongation in the etiology of stent graft migration after endovascular abdominal aortic aneurysm repair with a passive fixation device. J Vasc Surg 2006;44:1176–1181.PubMedCrossRefGoogle Scholar
  66. 66.
    Schlosser FJ, Mojibian H, Verhagen HJ, et al. Open thoracic or thoracoabdominal aortic aneurysm repair after previous abdominal aortic aneurysm surgery. J Vasc Surg 2008;48:761–768.PubMedCrossRefGoogle Scholar
  67. 67.
    Clouse WD, Marone LK, Davison JK, et al. Late aortic and graft-related events after thoracoabdominal aneurysm repair. J Vasc Surg 2003;37:254–261.PubMedCrossRefGoogle Scholar
  68. 68.
    Menke V, Castenmiller PH, Versteijlen RJ, Van der Laan L. Stent grafting a ruptured para-anastomotic iliac aneurysm. Vasc Endovascular Surg 2010;44:479–482.PubMedCrossRefGoogle Scholar
  69. 69.
    Morrissey NJ, Yano OJ, Soundararajan K, et al. Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: preferred treatment for a complex problem. J Vasc Surg 2001;34:503–512.PubMedCrossRefGoogle Scholar
  70. 70.
    Cochennec F, Marzelle J, Allaire E, et al. Open vs endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation. J Vasc Surg 2010;51:1360–1366.PubMedCrossRefGoogle Scholar
  71. 71.
    Greenhalgh RM, Brown LC, Powell JT, et al. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med 2010;362:1872–1880.PubMedCrossRefGoogle Scholar
  72. 72.
    Goodney PP, Tavris D, Lucas FL, et al. Causes of late mortality after endovascular and open surgical repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2010;51:1340–1347 e1341.PubMedCrossRefGoogle Scholar
  73. 73.
    Ten Bosch JA, Teijink JA, Willigendael EM, Prins MH. Endovascular aneurysm repair is superior to open surgery for ruptured abdominal aortic aneurysms in EVAR-suitable patients. J Vasc Surg 2010;52:13–18.PubMedCrossRefGoogle Scholar
  74. 74.
    Biancari F, Ylonen K, Anttila V, et al. Durability of open repair of infrarenal abdominal aortic aneurysm: a 15-year follow-up study. J Vasc Surg 2002;35:87–93PubMedGoogle Scholar
  75. 75.
    Conrad MF, Crawford RS, Pedraza JD, et al. Long-term durability of open abdominal aortic aneurysm repair. J Vasc Surg 2007;46:669–675.PubMedCrossRefGoogle Scholar
  76. 76.
    Greenhalgh RM, Brown LC, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010;362:1863–1871.PubMedCrossRefGoogle Scholar
  77. 77.
    Mayer D, Pfammatter T, Rancic Z, et al. 10 years of emergency endovascular aneurysm repair for ruptured abdominal aortoiliac aneurysms: lessons learned. Ann Surg 2009;249:510–515.PubMedCrossRefGoogle Scholar
  78. 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

Copyright information

© Hellenic Surgical Society 2012

Authors and Affiliations

  1. 1.1st Surgical Department, General Hospital “Laikon”, School of MedicineNational & Kapodistrian University of AthensAthensGreece

Personalised recommendations