title: Endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes.
abstract: BACKGROUND
  Proximal aortic control by endovascular balloon occlusion (EBO) is an alternative to conventional aortic cross-clamping (CAC) in hemodynamically unstable patients presenting with a ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the potential clinical benefit of EBO over CAC.
  
  
  METHODS
  Data from 72 patients with rAAA treated at our institution from 2001 to 2013 were retrospectively analyzed. All patients were hemodynamically unstable (mean arterial blood pressure at admission <65 mm Hg or associated unconsciousness, cardiac arrest, or emergency endotracheal intubation). Clinical end points of hemodynamic restoration, mortality rate, and major postoperative complications were assessed for CAC (group 1) and EBO (group 2).
  
  
  RESULTS
  At admission, 72 patients were unstable. CAC was performed in 40 and EBO in 32. Intraoperative mortality was 43% in group 1 vs 19% in group 2 (P = .031). In group 1, the approach for CAC (thoracotomy [n = 23] vs laparotomy [n = 17]) did not influence intraoperative mortality (43% vs 41%). There was no significant difference in 30-day (75% vs 62%) and in-hospital (77% vs 69%) mortality rates between groups. After EBO, the treatment-open vs endovascular repair-did not influence the intraoperative mortality rate (31% vs 43%; P = .5). Eight surgical complications were secondary to CAC (1 vena cava injury, 3 left renal vein injuries, 1 left renal artery injury, 1 pancreaticoduodenal vein injury, and 2 splenectomies), but no EBO-related complication was noted (P = .04). Differences in colon ischemia (15% vs 28%) and renal failure (12% vs 9%) were not statistically significant. Abdominal compartment syndrome occurred in four patients in group 2 and in no patients in group 1.
  
  
  CONCLUSIONS
  Compared with CAC, EBO is a feasible and valuable strategy and is associated with reduced intraoperative mortality of unstable rAAA patients, but not in-hospital mortality, in this retrospective study.
authors.affiliation: Department of Vascular Surgery, Hôpital Henri Mondor, Creteil, France. Electronic address: raux.maxime@gmail.com.
authors.forename: Maxime
authors.initials: M
authors.lastname: Raux
authors.affiliation: Department of Vascular Surgery, Hôpital Henri Mondor, Creteil, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Marzelle
authors.affiliation: Department of Vascular Imaging, Hôpital Henri Mondor, Creteil, France.
authors.forename: Hicham
authors.initials: H
authors.lastname: Kobeiter
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Hôpital Henri Mondor, Creteil, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
authors.affiliation: Department of Vascular Surgery, Hôpital Henri Mondor, Creteil, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Allaire
authors.affiliation: Department of Vascular Surgery, Hôpital Henri Mondor, Creteil, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Cochennec
authors.affiliation: Department of Vascular Surgery, Hôpital Henri Mondor, Creteil, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Becquemin
authors.affiliation: Department of Vascular Surgery, Hôpital Henri Mondor, Creteil, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Desgranges
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001019:Aortic Rupture / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D021721:Balloon Occlusion / Q000009:adverse effects / Q000401:mortality; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D003250:Constriction; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005602:France; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome