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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2002 June;43(3):369-78

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Endovascular approaches to ruptured infrarenal aorto-iliac aneurysms

Veith F. J., Ohki T.

From the Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, and Albert Einstein College of Medicine, New York, NY, USA


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Back­ground. Rup­tured abdom­inal aor­toi­liac aneu­rysms (­RAAAs) ­carry a ­high mor­tality ­when ­treated by ­open sur­gical ­repair. ­Since 1994, we ­have ­employed endo­vas­cular ­approaches to ­treat ­this ­entity.
­Methods. ­Patients ­with pre­sumed ­RAAAs ­were ­treated ­with ­restricted ­fluid resus­ci­ta­tion (hypo­ten­sive hemo­stasis), ­rapid trans­port to the oper­ating ­room, place­ment of a trans­bra­chial or trans­fe­moral guide­wire ­under ­local anes­thesia, and ­urgent arter­i­og­raphy. In ­patients ­with suit­able ­anatomy, endo­vas­cular ­graft ­repair was per­formed. If the ­anatomy was unsuit­able, stan­dard ­open ­repair was per­formed. If the ­patient had cir­cu­la­tory col­lapse, prox­imal bal­loon con­trol was ­employed.
­Results. Of 31 ­patients man­aged in ­this ­fashion, 25 under­went endo­vas­cular ­graft ­repair. Six ­required ­open ­repair. ­Total oper­a­tive mor­tality was 9.7% (3 ­patients). ­Only 10 ­patients ­required prox­imal bal­loon ­aortic con­trol.
Con­clu­sions. Endo­vas­cular tech­niques (prox­imal bal­loon con­trol and endo­grafts) may ­improve treat­ment out­comes for ­RAAAs. ­Restricted resus­ci­ta­tion (hypo­ten­sive hemo­stasis) can be effec­tive in the ­RAAA set­ting.

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