Emergency endovascular treatment of abdominal aortic aneurysms: feasibility and results.
OBJECTIVE
To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs).


METHODS
During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months.


RESULTS
Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension.


CONCLUSIONS
Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.
Laganà
Domenico
D
Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri, 57, Varese, 21100, Italy.
Carrafiello
Gianpaolo
G
Mangini
Monica
M
Fontana
Federico
F
Caronno
Roberto
R
Castelli
Patrizio
P
Cuffari
Salvatore
S
Fugazzola
Carlo
C
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004638:Emergency Treatment; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome