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Endovascular Management of Ruptured Abdominal Aortic Aneurysms: An 8-year Single-Centre Experience

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Abstract

We aimed to review our experience with the endovascular treatment of ruptured abdominal aortic aneurysm (RAAA). During an 8-year period, 69 patients with a RAAA presented to our department; 67 underwent assessment by computed axial tomography, and 2 died on arrival before any evaluation was possible. A total of 42 patients (63%) were suitable for stent-grafting, and all but 1 (c-arm failure) proceeded to endovascular repair. Of these, 27 underwent surgery with local anaesthesia; 3 did so under general anaesthesia; and a further 11 procedures were commenced with the patient under local anaesthesia and then converted to general anaesthesia. A total of 28 bifurcated and 14 aorto-uni-iliac stent-grafts were implanted. Aortic occlusion balloons were used in 2 (5%) patients. The in-hospital and the 30-day mortality rates were 36% and 41%, respectively. After surgery, 21 complications were encountered in 17 patients. Two patients required reintervention during their hospital stay (1 type I endoleak and 1 limb occlusion). During the follow-up (median 730 days [range 90 to 580 days]), the 1-year and 5-year cumulative survival probabilities were 53% (SE 7.9%) and 50% (SE 8.0%), respectively. Three reinterventions were necessary during follow-up (2 type I endoleaks and 1 graft occlusion). We conclude that endovascular treatment is feasible in the emergency setting, and the early experience is promising. Whether such an approach is superior to open surgery remains to be determined.

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References

  1. Heller JA, Weinberg A, Arons R et al (2000) Two decades of abdominal aortic aneurysm repair: have we made any progress? J Vasc Surg 32:1091–1100

    Article  PubMed  CAS  Google Scholar 

  2. Noel AA, Gloviczki P, Cherry KJ Jr et al (2001) Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair. J Vasc Surg 34:41–46

    Article  PubMed  CAS  Google Scholar 

  3. van Dongen HP, Leusink JA, Moll FL et al (1998) Ruptured abdominal aortic aneurysms: factors influencing postoperative mortality and long-term survival. Eur J Vasc Endovasc Surg 15:62–66

    Article  PubMed  Google Scholar 

  4. Bown MJ, Sutton AJ, Bell PR, Sayers RD (2002) A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 89:714–730

    Article  PubMed  CAS  Google Scholar 

  5. Papazoglou K, Christu K, Iordanides T et al (1999) Endovascular abdominal aortic aneurysm repair with percutaneous transfemoral prostheses deployment under local anaesthesia. Initial experience with a new, simple-to-use, tubular and bifurcated device in the first 27 cases. Eur J Vasc Endovasc Surg 17:202–207

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  7. Greenberg RK, Ouriel K, Shortell C et al (2000) An endoluminal method of hemorrhage control and repair of ruptured abdominal aortic aneurysms. J Endovasc Ther 7:1–7

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Veith FJ, Ohki T (2002) Endovascular approaches to ruptured infrarenal aortoiliac aneurysms. J Cardiovasc Surg 43:369–378

    CAS  Google Scholar 

  10. Yilmaz N, Peppelenbosch 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

    Article  PubMed  Google Scholar 

  11. Van Herzeele I, Vermassen F, Durieux C et al (2003) Endovascular repair of aortic rupture. Eur J Vasc Endovasc 26:311–316

    Article  Google Scholar 

  12. Scharrer-Pamler R, Kotsis T, Kapfer X, Gorich J, Sunder-Plassmann L (2003) Endovascular stent-graft repair of ruptured aortic aneurysms. J Endovasc Ther 10:447–452

    Article  PubMed  Google Scholar 

  13. Resch T, Malina M, Lindbland B, Dias NV, Sonesson B, Ivancev K (2003) Endovascular repair of ruptured abdominal aortic aneurysms: logistics and short-term results. J Endovasc Ther 10:440–446

    Article  PubMed  Google Scholar 

  14. Lee WA, Hirneise CM, Tayyarah M, Huber TS, Seeger JM (2004) Impact of endovascular repair on early outcomes of ruptured abdominal aortic aneurysms. J Vasc Surg 40:211–215

    Article  PubMed  Google Scholar 

  15. May J, White GH, Stephen MS, Harris JP (2004) Rupture of abdominal aortic aneurysm: concurrent comparison of outcome of those occurring after endovascular repair versus those occurring without previous treatment in an 11-year single-center experience. J Vasc Surg 40:860–866

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  17. Arya N, Lee B, Loan W, Johnston LC, Boyd CS, Hannon RJ et al (2004) Change in aneurysm diameter after stent-graft repair of ruptured abdominal aortic aneurysms. J Endovasc Ther 11:319–322

    Article  PubMed  Google Scholar 

  18. Gerassimidis TS, Papazoglou KO, Kamparoudis AG, Konstantinidis K, Karkos CD, Karamanos D et al (2005) Endovascular management of ruptured abdominal aortic aneurysms: 6-year experience from a Greek center. J Vasc Surg 42:615–623

    Article  PubMed  Google Scholar 

  19. Larzon T, Lindgren R, Norgren L (2005) Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm? J Endovasc Ther 12:548–555

    Article  PubMed  Google Scholar 

  20. Brandt M, Walluscheck KP, Jahnke T, Graw K, Cremer J, Muller-Hulsbeck S (2005) Endovascular repair of ruptured abdominal aortic aneurysm: feasibility and impact on early outcome. J Vasc Interv Radiol 16:1309–1312

    PubMed  Google Scholar 

  21. Peppelenbosch N, Cuypers PWM, Vahl AC, Vermassen F (2005) Buth J (2005) Emergency endovascular treatment for ruptured abdominal aortic aneurysm and the risk of spinal cord ischemia. J Vasc Surg 42:608–614

    Article  PubMed  Google Scholar 

  22. Alsac JM, Desgranges P, Kobeiter H, Becquemin JP (2005) Emergency endovascular repair for ruptured abdominal aortic aneurysms: feasibility and comparison of early results with conventional open repair. Eur J Vasc Endovasc Surg 30:632–639

    Article  PubMed  Google Scholar 

  23. Hechelhammer L, Lachat ML, Wildermuth S, Bettex D, Mayer D, Pfammatter T (2005) Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 41:752–757

    Article  PubMed  Google Scholar 

  24. Vaddineni SK, Russo GC, Patterson MA, Taylor SM, Jordan WD Jr (2005) Ruptured abdominal aortic aneurysm: a retrospective assessment of open versus endovascular repair. Ann Vasc Surg 19:782–786

    Article  PubMed  Google Scholar 

  25. Castelli P, Caronno R, Piffaretti G, Tozzi M, Lagana D, Carrafiello G et al (2005) Ruptured abdominal aortic aneurysm: endovascular treatment. Abdom Imaging 30:263–269

    Article  PubMed  CAS  Google Scholar 

  26. Dalainas I, Nano G, Bianchi P, Stegher S, Casana R, Malacrida G et al (2006) Endovascular techniques for the treatment of ruptured abdominal aortic aneurysms: 7-year intention-to-treat results. World J Surg 30:1809–1814

    Article  PubMed  Google Scholar 

  27. Oranen BI, Bos WTGJ, Verhoeven ELG, Tielliu IFG, Zeebregts CJ, Prins TR et al (2006) Is emergency endovascular aneurysm repair associated with higher secondary intervention risk at mid-term follow up? J Vasc Surg 44:1156–1161

    Article  PubMed  Google Scholar 

  28. Greco G, Egorova N, Anderson PL, Gelijns A, Moskowitz A, Nowygrod R et al (2006) Outcomes of endovascular treatment of ruptured abdominal aortic aneurysms. J Vasc Surg 43:453–459

    Article  PubMed  Google Scholar 

  29. Visser JJ, Bosch JL, Hunink MGM, van Dijk LC, Hendriks JM, Poldermans D et al (2006) Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: clinical outcomes with 1-year follow-up. J Vasc Surg 44:1148–1155

    Article  PubMed  Google Scholar 

  30. Hinchliffe RJ, Bruijstens L, MacSweeney STR, Braithwaite BD (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32:506–513

    Article  PubMed  CAS  Google Scholar 

  31. Acosta S, Lindblad B, Zdanowski Z (2007) Predictors for outcome after open and endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 33:277–284

    Article  PubMed  CAS  Google Scholar 

  32. Peppelenbosch N, Geelkerken RH, Soong C, Cao P, Steinmetz OK, Teijink JAW et al (2006) Endograft treatment of ruptured abdominal aortic aneurysms using the Talent aortouniiliac system: an international multicenter study. J Vasc Surg 43:1111–1122

    Article  PubMed  Google Scholar 

  33. Coppi G, Silingardi R, Gennai S, Saitta G, Ciardullo AV (2006) A single-center experience in open and endovascular treatment of hemodynamically unstable and stable patients with ruptured abdominal aortic aneurysms. J Vasc Surg 44:1140–1147

    Article  PubMed  Google Scholar 

  34. Franks S, Lloyd G, Fishwick G, Bown M, Sayers R (2006) Endovascular treatment of ruptured and symptomatic abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 31:345–350

    Article  PubMed  CAS  Google Scholar 

  35. Mehta M, Taggert J, Darling CIII et al (2006) Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg 44:1–8

    Article  PubMed  CAS  Google Scholar 

  36. Brennan J, McWilliams R (2004) The endovascular treatment of ruptured abdominal aortic aneurysms. In: Wyatt MG, Watkinson AF (eds) Endovascular intervention: current controversies. tfm Publishing Ltd, Shrewsbury, pp 19–25

    Google Scholar 

  37. Karkos CD, Rancic Z, Aksoy M, Svetlikov A, Spirin Y (2008) Endovascular repair of ruptured abdominal aortic aneurysms. In: Branchereau A, Jacobs M (eds) Endovascular aortic repair: the state of the art. Edizioni Minerva Medica, Turin, pp 141–153

    Google Scholar 

  38. Veith F (2005) Update on endovascular repair of ruptured abdominal aortic and thoracic aneurysms: the collected world experience. Abstract presentation at the 32nd Annual Veith Symposium, New York, NY, 17–20 November, 2005

  39. Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W (2007) Improved survival after introduction of an emergency endovascular therapy protocol for ruptured abdominal aortic aneurysms. J Vasc Surg 45:443–450

    Article  PubMed  Google Scholar 

  40. Visser JJ, van Sambeek MRHM, Hamza TH, Hunink MGM, Bosch JL (2007) Ruptured abdominal aortic aneurysms: endovascular repair versus open surgery—systematic review. Radiology 245:122–129

    Article  PubMed  Google Scholar 

  41. Kubin K, Sodeck GH, Teufelsbauer H, Nowatschka B, Kretschmer G, Lammer J, Schoder M (2008) Endovascular therapy of ruptured abdominal aortic aneurysm: mid- and long-term results. Cardiovasc Intervent Radiol 31:496–503

    Article  PubMed  Google Scholar 

  42. Rayt H, Lambert K, Bown M, Fishwick G, Morgan R, McCarthy M, London N, Sayers R (2008) Can surgeons assess CT suitability for endovascular repair (EVAR) in ruptured abdominal aortic aneurysm? Implications for a ruptured EVAR trial. Cardiovasc Intervent Radiol [Epub ahead of print]

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Authors and Affiliations

  1. Fifth Department of Surgery, Hippocrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Thomas S. Gerassimidis, Christos D. Karkos, Dimitrios G. Karamanos, Konstantinos O. Papazoglou, Dimitrios N. Papadimitriou, Filippos P. Demiropoulos, Dimitrios P. Malkotsis & Apostolos G. Kamparoudis

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  1. Thomas S. Gerassimidis
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  2. Christos D. Karkos
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  3. Dimitrios G. Karamanos
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  4. Konstantinos O. Papazoglou
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  5. Dimitrios N. Papadimitriou
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  7. Dimitrios P. Malkotsis
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  8. Apostolos G. Kamparoudis
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Correspondence to Christos D. Karkos.

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Gerassimidis, T.S., Karkos, C.D., Karamanos, D.G. et al. Endovascular Management of Ruptured Abdominal Aortic Aneurysms: An 8-year Single-Centre Experience. Cardiovasc Intervent Radiol 32, 241–249 (2009). https://doi.org/10.1007/s00270-008-9441-2

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  • DOI: https://doi.org/10.1007/s00270-008-9441-2

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