Endovascular repair of ruptured abdominal aortic aneurysm--a challenge to open repair? Results of a single centre experience in 20 patients.
BACKGROUND
The mortality from ruptured abdominal aortic aneurysm (AAA) remains in the region of 50% despite advances in critical care. Endovascular repair of AAA has been shown to be associated with reduced physiological stress in the elective setting. It is hypothesised that the reduced physiological stress associated with EVAR may improve the outcome in patients with ruptured AAA.


METHODS
A feasibility study of endovascular repair of ruptured AAA was undertaken at the University Hospital, Nottingham, U.K. between 1994 and 2000. Patients admitted with ruptured AAA were assessed by a team familiar with endovascular techniques for elective repair of AAA. After giving informed consent patients underwent spiral computed tomographic angiography (CTA) in the majority of cases. Patients were then transferred to the operating theatre for EVAR.


RESULTS
Twenty patients underwent repair of ruptured AAA. Of these 20 patients, seven were referred from another hospital. Eight patients were considered unfit for open repair. The median duration of procedure was 180 min (range 120-480) and median blood loss was 1200 ml (range 750-2000 ml). The overall peri-operative mortality was 45%. A number of intra-operative and peri-operative procedures (both open and endovascular) were required to ensure aneurysm exclusion and to deal with the complications of endovascular surgery.


CONCLUSIONS
Ruptured AAA remains a particularly hazardous condition to treat. There are a number of advantages of EVAR in this condition. A number of the problems early in the experience of EVAR have been addressed, but further experience is required to demonstrate its efficacy when compared with open repair.
Hinchliffe
R J
RJ
Department of Vascular and Endovascular Surgery, University Hospital, Nottingham, UK.
Yusuf
S W
SW
Macierewicz
J A
JA
MacSweeney
S T
ST
Wenham
P W
PW
Hopkinson
B R
BR
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D011183:Postoperative Complications; D015607:Stents; D014656:Vascular Surgical Procedures / Q000401:mortality