title: The utility of commercially available endografts in the treatment of contained ruptured abdominal aortic aneurysm with hemodynamic stability.
abstract: OBJECTIVE
  Food and Drug Administration-approved endografts are suitable for the elective repair of abdominal aortic aneurysms (AAAs) with favorable aneurysm anatomy. Our aim is to illustrate the feasibility and versatility of commercially available endografts for emergency AAA repair in hemodynamically stable AAA rupture.
  
  
  METHODS
  From June 2001 to July 2002, five patients presented with severe abdominal pain and were diagnosed with contained rupture of an infrarenal AAA. In all cases, patients were deemed unfit to withstand conventional open repair by both the referring outside medical center as well as our center's team. All patients were hemodynamically stable on arrival at our medical center. Measurement and selection of endovascular devices were based on computed tomography (CT) scans performed emergently at the outside referring center. The required emergently procured endografts were obtained within 2 to 4.5 hours (mean, 3.1 hours) of presentation. Complex anatomy at the proximal and distal fixation zones or difficult access was present in every case.
  
  
  RESULTS
  All patients survived endograft repair and had successful exclusion of their aneurysm sac on the basis of intraoperative arteriography and postoperative CT surveillance. All were discharged to home at baseline function within a mean of 6.8 days (range, 2-13 days). There were no deaths. There was one postoperative pulmonary embolism, one myocardial infarct, and one type 2 endoleak. Mean operative time and blood loss were 4.67 hours and 217 mL, respectively. At a mean follow-up of 18 months, CT scans showed stable or shrinking aneurysm sacs.
  
  
  CONCLUSIONS
  In patients with contained ruptured AAAs who present with hemodynamic stability and comorbidities that preclude open surgery, commercially available endografts are a versatile treatment option even in the face of complicated aneurysm anatomy.
authors.affiliation: Division of Vascular Surgery, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Lombardi
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Michael A
authors.initials: MA
authors.lastname: Golden
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Carpenter
authors.forename: Marc
authors.initials: M
authors.lastname: Mitchell
authors.forename: Clyde
authors.initials: C
authors.lastname: Barker
authors.forename: Amy
authors.initials: A
authors.lastname: McBride
authors.forename: Omaida C
authors.initials: OC
authors.lastname: Velazquez
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D006439:Hemodynamics; D006801:Humans; D014057:Tomography, X-Ray Computed