Management and endovascular treatment of symptomatic abdominal aortic aneurysms.
OBJECTIVE
Our aim is to verify the feasibility and effectiveness of endovascular treatment for symptomatic abdominal aortic aneurysms (AAAs) in urgencies and emergencies.


METHODS
Over the past 51 months, we treated 38 symptomatic AAAs with endovascular exclusion. In 23 haemodynamically stable patients, computed tomography (CT) angiography was performed before treatment, and AAA exclusion was carried out as an urgent procedure; 15 patients with haemorrhagic shock were examined by ultrasound (US) only in the emergency room whereas the procedure was carried out in emergency and planned using angiography. Time from presentation to treatment was 100 min on average (range: 50-150 min). We used 27 Excluder (Gore) and 11 Zenith (Cook) stentgrafts. The follow-up was performed with CT angiography after 1, 3, 6 and 12 months and yearly thereafter.


RESULTS
The immediate technical success rate was 100%, and the perioperative mortality rate was 10.5%. At follow-up completed in 34 patients (range: 1-48 months, mean: 19.2), we observed five endoleaks (14%) (four type 2: two thrombosed spontaneously and two were under observation at the time of writing; one type 3, treated with stent-graft extension) and one occlusion of a stentgraft leg (treated by femorofemoral bypass).


CONCLUSIONS
Endovascular treatment of AAAs is a good therapeutic alternative even in urgency and emergency conditions where correct planning ensures technical results comparable with those obtained under elective conditions.
Laganà
D
D
Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Viale Borri 57, I-21100 Varese, Italy. donlaga@gmail.com
Carrafiello
G
G
Mangini
M
M
Giorgianni
A
A
Caronno
R
R
Castelli
P
P
Dionigi
G
G
Cuffari
S
S
Fugazzola
C
C
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004638:Emergency Treatment / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography