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Endovascular treatment of ruptured abdominal aortic aneurysms: aorto-uni-iliac or bifurcated endograft?

Trattamento endovascolare di aneurismi dell’aorta addominale in rottura: endoprotesi aorto-uniliaca o biforcata?

  • Vascular and Interventional Radiology / Radiologia Vascolare e Interventistica
  • Published:
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Abstract

Purpose

This study evaluated the safety and technical and clinical success rates of positioning endovascular endografts (EG) in ruptured abdominal aneurysms.

Materials and methods

Patients with a ruptured abdominal aortic aneurysm confirmed by contrastenhanced computed tomography angiography (CTA) were eligible for the analysis. Of 67 patients, 42 (62.7%) were treated with EG. Thirteen patients (30.9%) received an aorto-uni-iliac EG (group A) and 29 a bifurcated EG (group B). Patients were divided for comparative analysis according to the configuration of the EG implanted.

Results

The primary technical success rate was 100%; the primary clinical success rate was 95% (40/42). There were two intraoperative deaths (4.7%) related to intractable shock. No patient required conversion to open repair. Overall, 12 patients (28.5%) died within 30 days. The inhospital death rate was 30.9% (13/42). Hospital mortality rate was statistically higher in group A; the type of EG and intensive care unit admission were the only independent predictors of hospital mortality.

Conclusions

In our experience, a higher mortality rate was observed for the aorto-uni-iliac configuration; shock at admission was confirmed as the most important factor for postoperative survival.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare sicurezza, successo tecnico e successo clinico nel posizionamento di endoprotesi (EP) con approccio endovascolare in pazienti con aneurisma dell’aorta addominale in rottura.

Materiali e metodi

Sono stati valutati 67 pazienti con aneurisma dell’aorta addominale in rottura, confermato mediante esame angio-tomografia computerizzata (TC). In 42 casi (62,7%) è stata posizionata endoprotesi: aorto-uniiliaca in 13 pazienti (30,9%) (gruppo A), e biforcata in 29 (gruppo B).

Risultati

Nel 95% dei casi (40/42) è stato ottenuto il successo tecnico. Le morti intra-operatorie sono state 2 (4,7%). In nessun paziente l’intervento è stato convertito in open. Dodici pazienti (28,5%) sono morti entro 30 giorni. La percentuale di morti durante il ricovero è stata del 30,9% (13/42). Mediante una analisi uni- e multivariata, i due gruppi sono risultati ben ponderati; lo shock è risultato statisticamente più frequente nel gruppo A. La percentuale di morte intra-ospedaliera è risultata statisticamente più alta nel gruppo A e questa era correlata al tipo di endoprotesi e all’accesso nella unità di terapia intensiva.

Conclusioni

Nella nostra esperienza, si è osservata una più alta mortalità nel gruppo in cui è stata posizionata una EP aorto-uni-iliaca; lo shock all’ingresso è risultato essere il fattore più importante da correlare con la sopravvivenza post-operatoria.

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Authors and Affiliations

  1. Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, 21100, Varese, Italy

    G. Carrafiello, D. Laganà, F. Fontana, M. Mangini, A. M. Ierardi, F. Piacentino, A. Canì, A. Di Massa & C. Fugazzola

  2. Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy

    G. Piffaretti & P. Castelli

  3. Cardiac Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy

    G. Mariscalco

  4. Anaesthesia and Palliative Care, Circolo University Hospital, Varese, Italy

    S. Cuffari

Authors
  1. G. Carrafiello
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  2. G. Piffaretti
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  3. D. Laganà
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  4. F. Fontana
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  5. M. Mangini
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  7. F. Piacentino
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  8. A. Canì
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  11. S. Cuffari
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  12. P. Castelli
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Correspondence to G. Carrafiello.

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Carrafiello, G., Piffaretti, G., Laganà, D. et al. Endovascular treatment of ruptured abdominal aortic aneurysms: aorto-uni-iliac or bifurcated endograft?. Radiol med 117, 410–425 (2012). https://doi.org/10.1007/s11547-011-0717-2

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  • DOI: https://doi.org/10.1007/s11547-011-0717-2

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