Ruptured abdominal aortic aneurysm: endovascular or open approach in a Dutch general hospital

AIM

We compared the outcomes of 56 patients with a ruptured abdominal aortic aneurysm (RAAA) who underwent either open repair or emergency endovascular aneurysm repair (eEVAR) in a general hospital. It seems feasible that the availability of eEVAR for treatment of RAAA could lead to a decrease in hospital mortality.

METHODS

We analyzed all admitted patients with a RAAA, between January 2006 and April 2008, eEVAR is compared to open repair. We studied 30 days mortality, intensive care unit stay, hospital stay, total blood loss and complications.

RESULTS

Fifteen eEVAR procedures (26.8%) were performed. Mortality in the eEVAR-group was 26%, in the open repair-group 46%. Mean intensive care unit stay was 3.9 days and 4.8 days in the eEVAR-group and open repair-group, respectively. Mean hospital stay was 13 days and 10.5 days. The average blood loss was 210cc and 2760cc. The amount of blood products for transfusion was significantly higher in the open repair. Overall complication rate was not significantly different in both treatment groups.

CONCLUSION

Treatment in a Dutch general hospital of a RAAA with an eEVAR procedure has a lower mortality in comparison to the open repair. Therefore, whenever possible the eEVAR is the preferred treatment method.

Surgical removal of an infected aortic endoprosthesis using a wire cutter

The purpose of this study is to report a new method of removing an infected endoprosthesis from the abdominal aorta using a wire cutter. A 65-year-old man with a ruptured abdominal aortic aneurysm was admitted to our hospital. He was treated with an endovascular abdominal endoprosthesis and discharged one week later. Three months after placement, the patient returned with an infection of the aortic endoprosthesis. The endoprosthesis had been fixed with barbs and hooks above the renal arteries and was surgically explanted by using a wire cutter to cut the hooks. The bare suprarenal stent was left in place. The patient was discharged one month after stent removal, and was treated with oral antibiotics for another ten weeks. At one year follow-up the patient showed no clinical, biochemical, or radiological signs of infection. In conclusion, infected endoprostheses should be surgically removed according to the medical literature. We recognize that removing a Zenith endoprostheses requires a dangerous operation because the hooks of the bare stent are engaged into the supra-renal aorta. This case report documents a new technique to safely remove an infected endoprosthesis with the help of a wire cutter.

Low-field versus high-field MR imaging of the knee: a comparison of signal behaviour and diagnostic performance

A prospective study was undertaken to compare MR imaging of the knee obtained with low-field and high-field systems. In 10 subjects, MR imaging of the knee was performed on a 0.2 T permanent magnet and on a 1.5 T superconductive system. Similar spin echo (SE) and 3D-FISP (3D Fourier transform with steady state precession) acquisitions were obtained. Comparative image analysis was performed independently by four radiologists. Results show that the image quality and diagnostic performance delivered by state-of-the-art 0.2 T and 1.5 T systems is equivalent. Advantages of the 1.5 T system included: better signal-to-noise ratio, shorter scan times, better visualization of asymptomatic grade 1 meniscal degeneration on SE images. Advantages of 0.2 T images were: decreased chemical shift, susceptibility and flow artifacts, improved evaluation of subchondral bone on 3D-FISP images, slightly better patient tolerance. We conclude that, for MR imaging of the knee, a low-field system is a cost-effective alternative to more expensive superconducting units.