Skip to main content
SpringerLink
Log in

Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

  • WORK IN PROGRESS
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs).

Methods

During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months.

Results

Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1–36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension.

Conclusions

Endovascular repair is a good option for emergency treatment of AAAs. The team’s experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2A–D

Similar content being viewed by others

References

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

    Article  CAS  PubMed  Google Scholar 

  2. 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 26:303–310

    Article  CAS  PubMed  Google Scholar 

  3. Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysm. Ann Vasc Surg 5:491–499

    Article  CAS  PubMed  Google Scholar 

  4. Garcia-Madrid C, Josa M, Riambau V, et al (2004) Endovascular versus open surgical repair of abdominal aortic aneurysm: A comparison of early and intermediate results in patients suitable for both techniques. Eur J Vasc Endovasc Surg 28:365–372

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  6. Van Herzeele I, Vermassen F, Durieux C, et al (2004) Endovascular repair of aortic ruptured. Eur J Vasc Endovasc Surg 26:311–316

    Google Scholar 

  7. Arko FR, Lee WA, Hill BB (2002) Aneurysm-related death: Primary endpoint analysis for comparison of open and endovascular repair. J Vasc Surg 36:297–304

    Article  PubMed  Google Scholar 

  8. Scharrer-Palmer R, Kotsis T, Kapfer X, et al (2003) Endovascular stent-graft repair of ruptured aortic aneurysms. J Endovasc Ther 10:447–452

    Google Scholar 

  9. Lachat ML, Pfammatter T, Witzke HJ (2002) Endovascular repair with bifurcated stent-graft under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Vasc Endovasc Surg 23:528–536

    Article  CAS  PubMed  Google Scholar 

  10. Veith F, Ohki T (2002) Endovascular approaches to ruptured infrarenal aortoiliac. J Cardiovascular Surg 43:369–378

    CAS  Google Scholar 

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

    PubMed  Google Scholar 

  12. 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 26:479–486

    Article  CAS  PubMed  Google Scholar 

  13. 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 22:528–534

    CAS  PubMed  Google Scholar 

  14. Lee WA, Huber TS, Hirneise CM, et al (2002) Eligibility rates of ruptured and symptomatic AAA for endovascular repair. Endovasc Ther 9:436–442

    Google Scholar 

  15. Veith FJ, Ohki T, Lipsitz EC, et al (2003) Endovascular grafts and other catheter-directed techniques in the management of ruptured abdominal aortic aneurysms. Semin Vasc Surg 16:326–331

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  17. Verhoeven EL, Prins TR, van den Dungen JJ, et al (2002) Endovascular repair of acute AAAs under local anesthesia with bifurcated endografts: A feasibility study. J Endovasc Ther 9:729–735

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Lombardi JV, Fairman RM, Golden MA, et al (2004) The utility of commercially available endografts in the treatment of contained ruptured abdominal aortic aneurysm with hemodynamic stability. J Vasc Surg 40:154–160

    Article  PubMed  Google Scholar 

  20. Doss M, Martens S, Hemmer W (2002) Emergency endovascular interventions for ruptured thoracic and abdominal aortic aneurysms. Am Heart J 144:544–548

    PubMed  Google Scholar 

  21. van Sambeek MR, van Dijk LC, Hendriks JM, et al (2002) Endovascular versus conventional open repair of acute abdominal aortic aneurysm: Feasibility and preliminary results. J Endovasc Ther 9:443–448

    PubMed  Google Scholar 

  22. Veith FJ, Gargiulo NJ 3rd, Ohki T (2003) Endovascular treatment of ruptured infrarenal aortic and iliac aneurysms. Acta Chir Belg 103:555–562

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  24. Treska V, Cechura M, Molacek J, et al (2003) Rupture of abdominal aortic aneurysm (RAAA): Predictors of the early postoperative mortality. Zentralbl Chir 128:557–560

    CAS  PubMed  Google Scholar 

  25. Willmann JK, Lachat ML, von Smekal A, et al (2001) Spiral-CT angiography to assess feasibility of endovascular aneurysm repair in patients with ruptured aortoiliac aneurysm. Vasa 30:271–276

    Article  CAS  PubMed  Google Scholar 

  26. Buth J, van Marrewijk CJ, Harris PL, et al (2002) EUROSTAR Collaborators. 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 35:211–221

    Article  PubMed  Google Scholar 

  27. Greenberg R, Fairman R, Srivastava S, et al (2000) Endovascular grafting in patients with short proximal necks: An analysis of short-term results. Cardiovasc Surg 8:350–354

    CAS  PubMed  Google Scholar 

  28. Ingle H, Fishwick G, Thompson MM, et al (2002) Endovascular repair of wide neck AAA: Preliminary report on feasibility and complications. Eur J Vasc Endovasc Surg 24:123–127

    Article  CAS  PubMed  Google Scholar 

  29. van Marrewijk C, Buth J, Harris PL, et al (2002) Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience. J Vasc Surg 35:461–473

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    Domenico Laganà, Gianpaolo Carrafiello, Monica Mangini, Federico Fontana & Carlo Fugazzola

  2. Department of Vascular Surgery, University of Insubria, Viale Borri, 57, Varese, 21100, Italy

    Roberto Caronno & Patrizio Castelli

  3. Department of Anesthesiology, University of Insubria, Viale Borri, 57, 21100, Varese, Italy

    Salvatore Cuffari

Authors
  1. Domenico Laganà
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianpaolo Carrafiello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monica Mangini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federico Fontana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Caronno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrizio Castelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salvatore Cuffari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlo Fugazzola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Domenico Laganà.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laganà, D., Carrafiello, G., Mangini, M. et al. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results. Cardiovasc Intervent Radiol 29, 241–248 (2006). https://doi.org/10.1007/s00270-005-0080-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-005-0080-6

Keywords

Search

Navigation