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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2012 December;19(4):245-51
Endovascular treatment of ruptured thoracic aortic aneurysms
Coppi G., Gennai S., Silingardi R., Saitta G., Trevisi Borsari G., Nijla M., Benassi F.
Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino-Estense Baggiovara, Modena, Italy
AIM: Retrospective evaluation of endovascular treatment of ruptured thoracic aortic aneurysms in a single centre.
METHODS: From June 1996 to April 2011, 150 patients were treated for thoracic aortic diseases. Of these, 12 patients were treated in emergency for ruptured thoracic aorta aneurysms (RTAA). RTAA wasdefined as peri-aortic extravasation of blood documented at pre-operative computed tomography scan, considered independent of the patients’ hemodynamic condition. The population was composed of 7 males (58.3%) and 5 females (41.7%), with a mean age of 77 years (71-82). The average maximum diameter of the treated aneurysms was 70.6 mm (50-80). Eight patients arrived at this center’s Emergency Department in a hemodynamically stable condition; conscious and/or with a systolic blood pressure > 80 mmHg, with or without fluid resuscitation. Access was achieved in the femoral artery in 83.3% and the iliac artery in the remaining patients (16.7%).
RESULTS: In all 12 cases the endograft was successfully deployed (100%). Three deaths (25%) were recorded within the first 30 days: 2 in the immediate post-operative period after confirmed complete exclusion of the aneurysm and 1 multi-organ failure at post-operative day 18. Six (50%) severe systemic complications were recorded in 4 patients. At a mean follow-up of 41.2 mths (3-85, SD±23.46), 3 endoleaks in 2 patients were recorded, which were successfully treated with additional endograft segments. Emergent surgical conversion was necessary in 1 patient for aorto-esophageal fistula bleeding. The patient died at postoperative day 1, leading to an overall re-intervention rate of 33.3%.
CONCLSION: Overall results of this study, although numerically limited, appear to be satisfactory, especially considering the advanced age and high surgical risk of the treated population.
Comprehensive evidence that rTEVAR improves survival when compared with open surgery is still required. However large randomized studies are unlikely to apply to this rare and urgent pathology.