Endovascular treatment of ruptured abdominal aortic aneurysms: is now EVAR the first choice of treatment?

Cardiovasc Intervent Radiol. 2014 Oct;37(5):1156-64. doi: 10.1007/s00270-013-0782-0.

Abstract

Objective: This study was designed to evaluate the effectiveness of endovascular treatment (EVAR) for ruptured abdominal aortic aneurysms (rAAAs).

Methods: Between September 2005 and December 2012, 44 patients with rAAA suitable for endovascular repair underwent emergency EVAR. We did not consider hemodynamic instability to be a contraindication for EVAR.

Results: Successful stent-graft deployment was achieved in 42 patients, whereas 2 required open surgical conversion. The overall 30-day mortality was 10 of 44 patients (5/34 in stable patients, 5/10 in unstable patients). Postoperative complications were observed in 7 of 44 patients (16 %): 5 patients developed abdominal compartment syndrome requiring decompressive laparotomy; 1 patient developed bowel ischemia; 1 patient had limb ischemia, and 1 had hemodynamic shock. Mean length of intensive care unit stay was 2.9 (range 2–8) days, and mean length of hospital stay was 8.6 (range 0–18) days. At a mean follow-up of 22.2 (range 1–84) months, the overall incidence of endoleak was 23.5 %: 1 type I and 7 type II endoleaks.

Conclusions: Our study demonstrates that EVAR of rAAA is associated with acceptable mortality and morbidity rates in dedicated centers.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal / epidemiology
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / epidemiology
  • Aortic Rupture / surgery*
  • Blood Vessel Prosthesis Implantation / methods*
  • Endovascular Procedures / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Length of Stay / statistics & numerical data
  • Male
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Stents*
  • Treatment Outcome