title: Endovascular aneurysm sealing for the treatment of ruptured abdominal aortic aneurysms.
abstract: OBJECTIVE
  To assess the feasibility and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS), a novel therapeutic alternative whose feasibility has not been established in rAAAs due to the unknown effects of the rupture site on the ability to achieve sealing.
  
  
  METHODS
  Between December 2013 and April 2014, 5 patients (median age 71 years, range 57-90; 3 men) with rAAAs were treated with the Nellix EVAS system at a single institution. Median aneurysm diameter was 70 mm (range 67-91). Aneurysm morphology in 4 of the 5 patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent-grafts; the remaining patient was outside the IFU for standard stent-grafts but treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range 0-3). Two patients died of multiorgan failure after re-laparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up 9.2 months).
  
  
  CONCLUSIONS
  EVAS for the management of infrarenal rAAAs appears feasible. The use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology.
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK jorgldebruin@gmail.com.
authors.forename: Jorg L
authors.initials: JL
authors.lastname: de Bruin
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Jack R W
authors.initials: JR
authors.lastname: Brownrigg
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Benjamin O
authors.initials: BO
authors.lastname: Patterson
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Peter J E
authors.initials: PJ
authors.lastname: Holt
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Morgan
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Loftus
authors.affiliation: St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; aneurysm sac; complications; endobag; endovascular aneurysm sealing; mortality; ruptured aneurysm; stent-graft