Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms.
OBJECTIVE
We sought to analyze the clinical and morphologic outcomes of bifurcated stent grafts in patients with ruptured aortoiliac aneurysms at midterm follow-up.


METHODS
Thirty-seven patients (4 women; mean age, 73 years; mean abdominal aortic aneurysm [AAA] diameter, 77 mm) underwent endovascular abdominal aneurysm repair between June 1997 and July 2003 for ruptured AAA. Devices inserted were as follows: Vanguard (Boston Scientific, Natick, Mass; n = 7), Excluder (W.L. Gore, Flagstaff, Ariz; n = 25), Talent (Medtronic Vascular, Santa Rosa, Calif; n = 2), and Zenith (Cook Inc, Bloomington, Ind; n = 3). Except for the adjunct postimplantation computed tomographic scanning, the imaging follow-up was the same as for nonruptured AAAs.


RESULTS
The mean follow-up period was 24 months (range, 1-59) months. Thirty-day mortality was 10.8%. Three patients died during the follow-up of non-AAA-related causes. One patient was converted early for presumed renal overstenting. The late conversion rate was 9% because of stent graft migration (n = 2) or infection (n = 1). Freedom from endoleak was 57% +/- 8.5% and 48.8% +/- 9% at 2 and 4 years, respectively. Seventeen secondary interventions were performed during the follow-up period, 41% of these within 1 month of stent graft placement. Endoleaks, primary or secondary, were responsible for 58.8% of these interventions. The cumulative risk of a secondary intervention was 35.3% +/- 9% at 2 years and 44.6% +/- 11% at 3 years. Aneurysmal sac shrinkage was observed in 30.8% +/- 9.1% and sac enlargement was observed in 15.3% +/- 10.8% at 2 years.


CONCLUSIONS
Endoluminal devices are able to convert the acute life-threatening situation of ruptured AAA to a controlled situation that results in good patient survival at midterm follow-up.
Hechelhammer
Lukas
L
Institute of Diagnostic Radiology, University Hospital of Zurich, CH 8091 Zurich, Switzerland.
Lachat
Mario L
ML
Wildermuth
Simon
S
Bettex
Dominique
D
Mayer
Dieter
D
Pfammatter
Thomas
T
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome