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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Journal of Vascular and Endovascular Surgery 2009 Giugno;16(2):75-83
Endovascular treatment for ruptured abdominal aortic aneurysms
Piffaretti G. 1, Mariscalco G. 2, Bacuzzi A. 3, Tozzi M. 1, Carrafiello G. 4, Lomazzi C. 1, Rivolta N. 1, Castelli P. 1
1 Unit of Vascular Surgery, Department of Surgical Sciences University of Insubria, Varese, Italy
2 Unit of Cardiac Surgery, Department of Surgical Sciences University of Insubria, Varese, Italy
3 Department of Anesthesia and Palliative Care Circolo University Hospital, Varese, Italy
4 Unit of Interventional Radiology, Department of Radiology University of Insubria, Varese, Italy
Aim. The authors report the results of their retrospective study comparing the outcome for the different endograft configuration.
Methods. Only patients with a ruptured abdominal aortic aneurysm (rAAA) confirmed by contrast enhanced computed-tomography-angiography (CTA) were eligible for the analysis. Out of a group of 67 patients, 42 patients (62.7%) were treated with endograft (EG). Patients were divided for comparative analysis according to the configuration of the EG implanted. Twenty-five patients (59.5%) were operated on general anesthesia and orotracheal intubation. Thirteen patients (30.9%) received an aorto-uni-iliac (AUI) EG (group A), and 29 a bifurcated EG (group B). Data base included 29 variables (18 preoperative, 8 intraoperative, 3 postoperative).
Results. Primary technical success rate was 95% (40/42). No patient required conversion to open repair. Overall, a total of 12 patients (28.5%) died within 30 days: there were 2 intraoperative deaths (4.7%), 9 patients died within 48 hours of operation, 3 further patients within two weeks. Hospitalization death rate was 30.9% (13/42). At univariate and multivariate analyses, the subgroups were well-matched for gender, age, aneurysm size and morphology, type of diagnosis, delay, and values of the parameters at admission; shock was statistically more frequent in the group A. Hospital mortality was statistically higher in group A; type of EG and intensive care unit admission were the only independent predictors of hospital mortality.
Conclusion. In the authors’ experience, a higher mortality rate for the AUI configuration was observed; shock at admission was confirmed the most important factor for postoperative survival.