title: Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms.
abstract: 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.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital of Zurich, CH 8091 Zurich, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Hechelhammer
authors.forename: Mario L
authors.initials: ML
authors.lastname: Lachat
authors.forename: Simon
authors.initials: S
authors.lastname: Wildermuth
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettex
authors.forename: Dieter
authors.initials: D
authors.lastname: Mayer
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfammatter
mesh_terms: 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