Successful use of emergent endovascular aneurysm repair for a ruptured hypotensive abdominal aortic aneurysm

Maria Basile, Fred Fiesseler, Richard D. Shih

Morristown Medical Center, Morristown, USA;.

DOI: 10.4236/crcm.2013.22036                

Abstract

Ruptured aortic aneurysm has a surgical mortality ranging from 50%-70%, one of the highest rates of all vascular emergencies [1-5]. Less invasive approaches to repair have been developed that could potentially improve these statistics [1,5-7]. Endovascular aneurysm repair (EVAR) is a minimally invasive approach that may be an alternative to open surgical repair for select cases of ruptured aortic aneurysms [1,5]. Unfortunately, the role of EVAR in patients with acute rupture of an abdominal aneurysm is not clear, especially for patients that are hemodynamically unstable [1,8-10]. The literature is limited regarding use of EVAR in this population of patients. We present a case of the successful use of EVAR for an emergent repair in a hypotensive hemodynamically unstable patient with an acutely ruptured abdominal aortic aneurysm (AAA).

Keywords

Abdominal Aortic Aneurysm; Aneurysm; Endovascular Aneurysm Repair

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Moll, F.L., et al. (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the european society for vascular surgery. European Journal of Vascular and Endovascular Surgery, 41, S1-S58. doi:10.1016/j.ejvs.2010.09.011
[2]	Bonardelli, S., et al. (2011) Open surgery in endovascular aneurysm repair era: Simplified classification in two risk groups owing to factors affecting mortality in 137 ruptured abdominal aortic aneurysms (RAAAs). Updates in Surgery, 63, 39-44. doi:10.1007/s13304-011-0053-z
[3]	Katz, D.J., Stanley, J.C. and Zelenock, G.B. (1994) Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: An eleven-year statewide experience. Journal of Vascular Surgery, 19, 804-817. doi:10.1016/S0741-5214(94)70005-2
[4]	Egorova, N., et al. (2008) National outcomes for the treatment of ruptured abdominal aortic aneurysm: Comparison of open versus endovascular repairs. Journal of Vascular Surgery, 48, 1092-100. doi:10.1016/j.jvs.2008.06.036
[5]	Veith, F.J., et al. (2003) Treatment of ruptured abdominal aneurysms with stent grafts: A new gold standard? Seminars in Vascular Surgery, 16, 171-175. doi:10.1016/S0895-7967(03)00003-6
[6]	Larzon, T., Lindgren, R. and Norgren, L. (2005) Endovascular treatment of ruptured abdominal aortic aneurysms: A shift of the paradigm? Journal of Endovascular Therapy, 12, 548-555. doi:10.1583/04-1469.1
[7]	Lyons, O.T.A., et al. (2010) Emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysm: The way forward? Vascular, 18, 130-135. doi:10.2310/6670.2010.00033
[8]	Karkos, C.D., et al. (2009) Mortality after endovascular repair of ruptured abdominal aortic aneurysms: A systematic review and meta-analysis. Archives of Surgery, 144, 770-778. doi:10.1001/archsurg.2009.132
[9]	Azizzadeh, A., et al. (2008) Endovascular repair of ruptured abdominal aortic aneurysms: Systematic literature review. Vascular, 16, 219-224. doi:10.2310/6670.2008.00039
[10]	Veith, F.J., et al. (2010) Is a randomized trial necessary to determine whether endovascular repair is the preferred management strategy in patients with ruptured abdominal aortic aneurysms? Journal of Vascular Surgery, 52, 1087-1093. doi:10.1016/j.jvs.2010.05.142
[11]	Gerassimidis, T.S., et al. (2005) Endovascular management of ruptured abdominal aortic aneurysms: 6-year experience from a Greek center. Journal of Vascular Surgery, 42, 615-623. doi:10.1016/j.jvs.2005.05.061
[12]	Franks, S., et al. (2006) Endovascular treatment of ruptured and symptomatic abdominal aortic aneurysms. European Journal of Vascular and Endovascular Surgery, 31, 345-350. doi:10.1016/j.ejvs.2005.08.037
[13]	Hinchliffe, R.J., Braithwaite, B.D. and Hopkinson, B.R. (2003) The endovascular management of ruptured abdominal aortic aneurysms. European Journal of Vascular and Endovascular Surgery, 25, 191-201. doi:10.1053/ejvs.2002.1846
[14]	Hinchliffe, R.J., et al. (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—Results of a pilot study and lessons learned for future studies. European Journal of Vascular and Endovascular Surgery, 32, 506-515. doi:10.1016/j.ejvs.2006.05.016
[15]	Hinchliffe, R.J., et al. (2009) Endovascular repair of ruptured abdominal aortic aneurysm: A strategy in need of definitive evidence. Journal of Vascular Surgery, 49, 1077-1080. doi:10.1016/j.jvs.2009.02.005
[16]	Veith, F.J., et al. (2009) Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Annals of Surgery, 250, 1-7. doi:10.1097/SLA.0b013e3181bdd7f5
[17]	Vaddineni, S.K., et al. (2005) Ruptured abdominal aortic aneurysm: A retrospective assessment of open versus endovascular repair. Annals of Vascular Surgery, 19, 782-786. doi:10.1007/s10016-005-7975-1
[18]	Hinchliffe, R.J. and Braithwaite, B.D. (2007) Ruptured abdominal aortic aneurysm: Endovascular repair does not confer any long-term survival advantage over open repair. Vascular, 15, 191-196. doi:10.2310/6670.2007.00045
[19]	Van Herzeele, I., et al. (2003) Endovascular repair of aortic rupture. European Journal of Vascular and Endovascular Surgery, 26, 311-316. doi:10.1053/ejvs.2002.2007
[20]	Mehta, M., et al. (2006) Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: Outcomes of a prospective analysis. Journal of Vascular Surgery, 44, 1-8. doi:10.1016/j.jvs.2006.02.057