title: Extended use of endovascular aneurysm sealing for ruptured abdominal aortic aneurysms.
abstract: Endovascular repair of abdominal aortic aneurysms (EVAR) is now an established treatment modality for suitable patients presenting with aneurysm rupture. EVAR for ruptured aneurysms reduces transfusion, mechanical ventilation, intensive care. and hospital stay when compared with open surgery. In the emergency setting, however, EVAR is limited by low applicability due to adverse clinical or anatomical characteristics and increased need for reintervention. In addition, ongoing bleeding from aortic side branches post-EVAR can cause hemodynamic instability, larger hematomas, and abdominal compartment syndrome. Endovascular aneurysm sealing, based on polymer filling of the aneurysm, has the potential to overcome some of the limitations of EVAR for ruptured aneurysms and to improve outcomes. Recent literature suggests that endovascular aneurysm sealing can be performed with early mortality similar to that of EVAR for ruptured aortic aneurysms, but experience is limited to a few centers and a small number of patients. The addition of chimney grafts can increase the applicability of endovascular aneurysm sealing in order to treat short-neck and juxtarenal aneurysms as an alternative to fenestrated endografts. Further evaluation of the technique, with larger longitudinal studies, is necessary before advocating wider implementation of endovascular aneurysm sealing in the emergency setting.
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: dittmar.boeckler@med.uni-heidelberg.de.
authors.forename: Dittmar
authors.initials: D
authors.lastname: Böckler
authors.affiliation: Auckland City Hospital, Auckland, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Holden
authors.affiliation: Stradins University Hospital, Riga, Latvia.
authors.forename: Dainis
authors.initials: D
authors.lastname: Krievins
authors.affiliation: St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Andreas S
authors.initials: AS
authors.lastname: Peters
authors.affiliation: Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Geisbüsch
authors.affiliation: Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Reijnen
mesh_terms: 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; D000072226:Computed Tomography Angiography; D004630:Emergencies; D057867:Endoleak / Q000209:etiology / Q000517:prevention & control; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome