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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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