REVIEWS  THE MANAGEMENT OF RUPTURED ABDOMINAL AORTIC ANEURYSMS 

The Journal of Cardiovascular Surgery 2009 October;50(5):595-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Choice of treatment for the patient with urgent AAA: practical tips

Mayer D. ¹, Rancic Z. ¹, Pfammatter T. ², Veith F. J. ^{3, 4}, Lachat M. ¹

¹ Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland 2 Interventional Radiology, University Hospital Zurich, Zurich, Switzerland 3 The Cleveland Clinic and New York University Medical Center New York, NY, USA 4 University Hospital Zurich, Zurich, Switzerland

Since the first successful attempts of emergency endovascular aneurysm repair (eEVAR) for patients with ruptured AAAs in the mid 1990s, surgeons have had to decide whether to treat patients by conventional open surgery or by minimally invasive but technically more demanding eEVAR. To date, selection of patients for eEVAR is still heavily debated and factors like hemodynamic instability, fear of treatment delay for patient transfer or imaging procedures and logistic issues often lead to the exclusion of anatomically suitable patients from eEVAR. However, these adverse factors may be overcome by adherence to an appropriate (intention-to-treat) protocol employing the use of a hypotensive hemostatic approach, transfemoral aortic balloon occlusion technique (when needed), different types of devices and an appropriate plan to resolve logistic issues, leaving anatomic suitability as the single most important determinant of suitability for EVAR