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Monge M, Eskandari MK. Strategies for Ruptured Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2008; 19:S44-50. [DOI: 10.1016/j.jvir.2008.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 02/11/2008] [Accepted: 02/11/2008] [Indexed: 11/16/2022] Open
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Arthurs ZM, Sohn VY, Starnes BW. Ruptured Abdominal Aortic Aneurysms: Remote Aortic Occlusion for the General Surgeon. Surg Clin North Am 2007; 87:1035-45, viii. [DOI: 10.1016/j.suc.2007.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dillon M, Cardwell C, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev 2007:CD005261. [PMID: 17253551 DOI: 10.1002/14651858.cd005261.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An abdominal aortic aneurysm (AAA) (the pathological enlargement of the aorta) can develop in both men and women as they grow older. It is most commonly seen in men over the age of 65 years. Progressive aneurysm enlargement can lead to rupture and massive internal bleeding, a fatal event unless timely repair can be achieved. Despite improvements in perioperative care, mortality remains high (approximately 50%) after conventional open surgical repair. A newer minimally invasive technique, endovascular repair, has been shown to reduce early morbidity and mortality, as compared to conventional open surgery, for planned AAA repair. Emergency endovascular repair (eEVAR) has been used successfully to treat ruptured abdominal aortic aneurysm (RAAA), proving that it is feasible in selected patients. However, it is not yet known if eEVAR will lead to significant improvements in outcomes for these patients or indeed if it can replace conventional open repair as the preferred treatment for this lethal condition. OBJECTIVES To compare the advantages and disadvantages of eEVAR in comparison with conventional open surgical repair for the treatment of RAAA. SEARCH STRATEGY The Cochrane Peripheral Vascular Diseases Group searched their trials register (last searched October 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) database (last searched Issue 4, 2006). We searched a number of electronic databases and handsearched relevant journals until March 2006 to identify studies for inclusion. SELECTION CRITERIA Randomised controlled trials in which patients with a confirmed ruptured abdominal aortic aneurysm were randomly allocated to eEVAR, or conventional open surgical repair. DATA COLLECTION AND ANALYSIS Studies identified for potential inclusion were independently assessed for eligibility by at least two reviewers, with excluded studies further checked by the agreed arbitrators. As no randomised controlled trials were identified at present no tests of heterogeneity or sensitivity analysis were performed. MAIN RESULTS There were no randomised controlled trials identified at present comparing eEVAR with conventional open surgical repair for the treatment of RAAA. AUTHORS' CONCLUSIONS There is no high quality evidence to support the use of eEVAR in the treatment of RAAA. However, evidence from prospective controlled studies without randomisation, prospective studies, and retrospective case series suggest that eEVAR is feasible in selected patients, with outcomes comparable to best conventional open surgical repair for the treatment of RAAA . Furthermore, endovascular repair in selected patients may be associated with a trend towards reductions in blood loss, duration of intensive care treatment, and mortality.
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Affiliation(s)
- M Dillon
- Royal Victoria Hospital, Vascular Surgery Unit, Grosvenor Road, Belfast, Northern Ireland, UK.
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Wilson WRW, Choke EC, Dawson J, Loftus IM, Thompson MM. Contemporary management of the infra-renal abdominal aortic aneurysm. Surgeon 2006; 4:363-71. [PMID: 17152201 DOI: 10.1016/s1479-666x(06)80112-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abdominal aortic aneurysms (AAAs) principally affect men over 60 years of age. Aneurysms are usually asymptomatic and detected coincidentally or following the onset of symptoms. Elective repair of an AAA is considered when the diameter reaches 5.5cm or annual expansion exceeds 1 cm. Rupture represents a catastrophic event and carries an unacceptably high mortality. The advent of endovascular repair heralds an improvement in operative outcome for this disease process. In this review we provide an overview of the recent trials investigating the management of non-ruptured and ruptured aneurysms and the strategies that may be invoked to lower the mortality of this disease process
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Affiliation(s)
- W R W Wilson
- Department of Vascular Surgery, University Hospital Nottingham, Queen's Medical Centre, Nottingham, UK
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Veith FJ, Ohki T, Lipsitz EC, Suggs WD, Cynamon J. Endovascular grafts and other catheter-directed techniques in the management of ruptured abdominal aortic aneurysms. Semin Vasc Surg 2003; 16:326-31. [PMID: 14691775 DOI: 10.1053/j.semvascsurg.2003.08.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abdominal aortoiliac aneurysms that are ruptured and treated with open surgical repair have high morbidity and mortality rates. We have employed endovascular approaches to treat this entity since 1994. Patients with presumed ruptured aortoiliac aneurysms were treated with restricted fluid resuscitation (hypotensive hemostasis), transport to the operating room, placement under local anesthesia of a brachial or femoral guidewire into the supraceliac aorta and arteriography. If aortoiliac anatomy was suitable, an endovascular graft repair was performed. If the anatomy was unfavorable, the aneurysm was repaired in a standard open fashion. Only if circulatory collapse occurred was a supraceliac balloon placed and inflated using the previously positioned guidewire. Of 36 patients so managed, 30 underwent endovascular graft repair and six required open repair. Four patients died within 30 days (operative mortality = 11%). Only 10 patients required supraceliac balloon control. Endovascular grafts, when combined with hypotensive hemostasis and other endovascular techniques, including proximal balloon control, may improve treatment outcomes with ruptured abdominal aortoiliac aneurysms. These techniques should become widely used for the treatment of ruptured aneurysms.
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Affiliation(s)
- Frank J Veith
- Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY 10467, USA
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Van Herzeele I, De Waele JJ, Vermassen F. Translumbar Extraperitoneal Decompression for Abdominal Compartment Syndrome After Endovascular Treatment of a Ruptured AAA. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0933:tedfac>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Verhagen HJM, Prinssen M, Milner R, Blankensteijn JD. Endoleak After Endovascular Repair of Ruptured Abdominal Aortic Aneurysm:Is It a Problem? J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0766:eaeror>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Veith FJ, Ohki T, Lipsitz EC, Suggs WD, Cynamon J. Treatment of ruptured abdominal aneurysms with stent grafts: a new gold standard? Semin Vasc Surg 2003; 16:171-5. [PMID: 12920689 DOI: 10.1016/s0895-7967(03)00003-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ruptured abdominal aortoiliac aneurysms, when treated with open surgical repair, have high morbidity and mortality rates. Since 1994, the authors have used endovascular approaches to treat this entity. Patients with presumed ruptured aortoiliac aneurysms were treated with restricted fluid resuscitation (hypotensive hemostasis), transport to the operating room, placement under local anesthesia of a brachial or femoral guide wire into the supraceliac aorta, and arteriography. If aortoiliac anatomy was suitable, an endovascular graft (stent-graft) repair was performed. If the anatomy was unfavorable, standard open repair was performed. Only if circulatory collapse occurred was a supraceliac balloon placed and inflated using the previously positioned guidewire. Of 35 patients treated in this manner, 29 underwent endovascular graft repair, and 6 required open repair. Four patients died within 30 days (operative mortality rate, 11%). Only 10 patients required supraceliac balloon control. Endovascular grafts, when combined with hypotensive hemostasis and other endovascular techniques including proximal balloon control, may improve treatment outcomes with ruptured abdominal aortoiliac aneurysms. The authors believe these techniques will become widely used for the treatment of ruptured aneurysms.
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Affiliation(s)
- Frank J Veith
- Montefiore Medical Center, Albert Einstein College of Medicine, 11 East 210th Street, New York, NY 10467, USA
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Rose DFG, Davidson IR, Hinchliffe RJ, Whitaker SC, Gregson RH, MacSweeney ST, Hopkinson BR. Anatomical Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Repair. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0453:asoraa>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Resch T, Malina M, Lindblad B, Dias NV, Sonesson B, Ivancev K. Endovascular Repair of Ruptured Abdominal Aortic Aneurysms:Logistics and Short-term Results. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0440:eroraa>2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scharrer-Pamler R, Kotsis T, Kapfer X, Görich J, Sunder-Plassmann L. Endovascular Stent-Graft Repair of Ruptured Aortic Aneurysms. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0447:esrora>2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Teijink JAW, Odink HF, Bendermacher B, Welten RJTJ, Veldhuijzen van Zanten GO. Ruptured AAA in a Patient With a Horseshoe Kidney:Emergent Treatment Using the Talent Acute Endovascular Aneurysm Repair Kit. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0240:raiapw>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Teufelsbauer H, Prusa AM, Prager M, Thurnher S, Lammer J, Hölzenbein T, Kretschmer G, Huk I, Polterauer P. Endovascular Treatment of a Multimorbid Patient With Late AAA Rupture After Stent-Graft Placement:1-year Follow-up. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0896:etoamp>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Verhoeven ELG, Prins TR, van den Dungen JJAM, Tielliu IFJ, Hulsebos RG, van Schilfgaarde R. Endovascular Repair of Acute AAAs Under Local Anesthesia With Bifurcated Endografts:A Feasibility Study. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0729:eroaau>2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lee WA, Huber TS, Hirneise CM, Berceli SA, Seeger JM. Eligibility Rates of Ruptured and Symptomatic AAA for Endovascular Repair. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0436:eroras>2.0.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yilmaz N, Peppelenbosch N, Cuypers PWM, Tielbeek AV, Duijm LEM, Buth J. Emergency Treatment of Symptomatic or Ruptured Abdominal Aortic Aneurysms:The Role of Endovascular Repair. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0449:etosor>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lobato AC, Rodriguez-Lopez J, Diethrich EB. Learning Curve for Endovascular Abdominal Aortic Aneurysm Repair:Evaluation of a 277-Patient Single-Center Experience. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0262:lcfeaa>2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Desai M, Baxter AB, Karmy-Jones R, Borsa JJ. Potentially life-saving role for temporary endovascular balloon occlusion in atypical mediastinal hematoma. AJR Am J Roentgenol 2002; 178:1180. [PMID: 11959727 DOI: 10.2214/ajr.178.5.1781180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Muneer Desai
- Department of Radiology, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA 98104-2499, USA
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Gandini R, Ippoliti A, Pampana E, Ascoli Marchetti A, Pistolese GR, Simonetti G. Emergency Endograft Placement for Recurrent Aortocaval Fistula After Conventional AAA Repair. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0208:eepfra>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kumar V, Campbell JH, Andy OJ, Hatten LE. Emergent Repair of a Ruptured Abdominal Aortic Aneurysm Using an AneuRx Stent-Graft. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0194:eroara>2.0.co;2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lyden SP, Sternbach Y, Waldman DL, Green RM. Clinical implications of internal iliac artery embolization in endovascular repair of aortoiliac aneurysms. Ann Vasc Surg 2001; 15:539-43. [PMID: 11665437 DOI: 10.1007/s10016-001-0001-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To overcome constraints imposed by iliac artery anatomy, the anatomic inclusion criteria for endovascular aortic aneurysm repair can be extended by means of intentional coil occlusion of one or both internal iliac arteries and extension of the distal limb of the graft into an external iliac artery. We reviewed our experience with this intervention to determine the safety and efficacy of this approach to aneurysm repair. Over a 30-month period, 84 patients underwent endovascular abdominal aortic aneurysm repair; 23 underwent intentional unilateral (22) or bilateral (1) internal iliac artery occlusion. Morbidity, mortality, and long-term clinical outcomes were evaluated in these 23 patients. Patients were specifically questioned about exercise-induced buttock and extremity symptoms. Our results showed that intentional internal iliac artery embolization to allow endovascular repair of abdominal aortic aneurysms is accompanied by significant morbidity and should be approached with caution.
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Affiliation(s)
- S P Lyden
- Center for Vascular Disease, Strong Memorial Hospital, Divisions of Vascular Surgery and Interventional Radiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 652, Rochester, NY 14642, USA
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Ramaiah VG, Thompson CS, Rodriguez-Lopez JA, DiMugno L, Olsen D, Diethrich EB. Endovascular Repair of AAA Rupture 20 Months After Endoluminal Stent-Grafting. J Endovasc Ther 2001. [DOI: 10.1583/1545-1550(2001)008<0125:eroarm>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bürger T, Halloul Z, Meyer F, Grote R, Lippert H. Emergency Stent-Graft Repair of a Ruptured Hepatic Artery Secondary to Local Postoperative Peritonitis. J Endovasc Ther 2000. [DOI: 10.1583/1545-1550(2000)007<0324:esgroa>2.3.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Scheinert D, Ludwig J, Steinkamp HJ, Schröder M, Balzer JO, Biamino G. Treatment of Catheter-Induced Iliac Artery Injuries With Self-Expanding Endografts. J Endovasc Ther 2000. [DOI: 10.1583/1545-1550(2000)007<0213:tociia>2.3.co;2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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