Endovascular versus Conventional Open Repair of Acute Abdominal Aortic Aneurysm: Feasibility and Preliminary Results

Abstract

Purpose:

To evaluate the feasibility of endovascular treatment of acute abdominal aortic aneurysm (AAA) with commercially prepared bifurcated systems.

Methods:

From January through July 2001, 22 patients (17 men; mean age 73.6 years, range 59–89) were referred with an acute (symptomatic/ruptured) AAA. Six patients were treated with emergent open surgery because of hemodynamic instability, but the other 16 patients underwent computed tomographic angiography with multidirectional reconstruction. Six (27%) aneurysms were suitable for endovascular repair (EVR) and were successfully treated. Procedural variables, morbidity, and mortality were compared between the EVR group and 6 patients of equivalent hemodynamic status from among the conventionally treated patients.

Results:

There was no mortality in either group. The median aneurysm diameter in the EVR group was 63 mm (range 48–84) versus 80 mm (45–82) in the matched surgically treated AAAs (p=0.628). Procedural duration was 193 minutes (150–265) for the EVR group compared to 203 minutes (130–270) for the matched group (p=0.630). Median blood loss was significantly less (p=0.010) in the EVR group (125 versus 3400 mL). Median length of stay (LOS) in intensive care was 8 hours (0–21) versus 62 hours (48–112) for the surgical group (p=0.004). Hospital LOS was significantly reduced (p=0.024) for the EVR patients (7.5 [2–16] versus 15.5 [10–34] days).

Conclusions:

Endovascular treatment of acute aneurysm is feasible, and preliminary results are promising.

Keywords

rupture symptomatic aneurysm Excluder endograft Zenith stent-graft

Get full access to this article

View all access options for this article.

References

Scott

Ashton

Kay

. Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years. BrJSurg. 1991;78:1122–1125.

Smith

FCT

Grimshaw

Paterson

. Ultrasonic screening for abdominal aortic aneurysm in an urban community. Br J Surg. 1993;80:1406–1409.

Lucarotti

Shaw

Poskitt

. The Gloucestershire aneurysm screening programme: the first 2 years' experience. Eur J Vasc Surg. 1993:7:397–401.

Collin

Araujo

Walton

. Oxford screening programme for abdominal aortic aneurysm in men aged 65 to 74 years. Lancet. 1988;2:613–615.

Pleumeekers

Hoes

van der Does

. Epidemiology of abdominal aortic aneurysms. Eur J Vasc Surg. 1994;8:119–128.

Cronenwett

Sargent

Wall

. Variables that affect the expansion rate and outcome of small abdominal aortic aneurysms. J Vasc Surg. 1990;11:260–269.

Limet

Sakalihassan

Albert

. Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms. J Vasc Surg. 1991;14:540–548.

Cronenwett

Murphy

Zelenock

. Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms. Surgery. 1985;98:472–483.

Nevitt

Ballard

Hallett

. Prognosis of abdominal aortic aneurysms. A population-based study. N Engl J Med. 1989;321:1009–1014.

10.

Johansson

Nydahl

Olofsson

. Survival in patients with abdominal aortic aneurysms. Comparison between operative and non-operative management. Eur J Vasc Surg. 1990;4:497–502.

11.

Glimåker

Holmberg

Elvin

. Natural history of patients with abdominal aortic aneurysm. Eur J Vasc Surg. 1991;5:125–130.

12.

The UK Small Aneurysm Trial Participants. Mortality results for randomised controlled trial of early elective surgery or ultrasonic surveillance for small abdominal aortic aneurysms. Lancet. 1998;352:1649–1654.

13.

Johnston

. Multicenter prospective study of non-ruptured abdominal aortic aneurysm. Part II: Variables predicting morbidity and mortality. J Vasc Surg. 1989;9:437–447.

14.

Johansson

Swedenborg

. Ruptured abdominal aortic aneurysms: a study of incidence and mortality. BrJSurg. 1986;73:101–103.

15.

Manfredini

Portaluppi

Grandi

. Out-of-hospital sudden death referring to an emergency department. J Clin Epidemiol. 1996;49:865–868.

16.

Bradbury

Makhdoomi

Adam

. Twelve-year experience of the management of ruptured abdominal aortic aneurysm. Br J Surg. 1997;84:1705–1707.

17.

Barry

Burke

Sheehan

. An “all comers” policy for ruptured abdominal aortic aneurysms: how can results be improved. Eur J Surg. 1998;164:263–270.

18.

Ernst

. Abdominal aortic aneurysm. N Engl J Med. 1993;328:1167–1172.

19.

Sayers

Thompson

Nasim

. Surgical management of 671 abdominal aortic aneurysms: a 13-year review from a single centre. Eur J Vasc Endovasc Surg. 1997;13:322–327.

20.

Ohki

Veith

Sanchez

. Endovascular graft repair of ruptured aortoiliac aneurysms. J Am Coll Surg. 1999;189:102–112.

21.

May

Schulze

. Successful completion of endoluminal repair of an abdominal aortic aneurysm after intraoperative iatrogenic rupture of aneurysm. J Vasc Surg. 1999;30:901–906.

22.

Ohki

Veith

. Endovascular therapy for ruptured abdominal aortic aneurysms. Adv Surg. 2001;35:131–151.

23.

Junnarkar

Reid

Johnston

. Endovascular repair for acute symptomatic and ruptured abdominal aortic aneurysms. Ulster Med J. 2001;70:51–53.

24.

Harris

Buth

Mialhe

. The need for clinical trials of endovascular abdominal aortic aneurysm stent-graft repair: The EUROSTAR Project. EUROpean collaborators on Stent-graft Techniques for abdominal aortic Aneurysm Repair. J Endovasc Surg. 1997;4:72–77.

25.

Rohrer

Cutler

Wheeler

. Long-term survival and quality of life following ruptured abdominal aortic aneurysm. Arch Surg. 1988;123:1213–1217.

26.

Magee

Scott

Dunkley

. Quality of life following surgery for abdominal aortic aneurysm. BrJSurg. 1992;79:1014–1016.

27.

Van Ramshorst

van der Griend

Eikelboom

. Survival and life quality after surgery for ruptured abdominal aneurysm. In: Greenhalgh

, ed. The Course and Management of Aneurysm. London: WB Saunders; 1990:433–440.

28.

Mangano

Browner

Hollenberg

. Association of perioperative myocardial ischemia with morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med. 1990;323:1781–1788.

29.

Poldermans

Boersma

Bax

. The effect of bisoprolol on perioperative mortality and myocardial infarction in high—risk patients undergoing major vascular surgery. N Engl J Med. 1999;341:1789–1794.

30.

Adriaensen

MEAPM

Bosch

Halpern

. Elective endovascular versus open surgical repair of abdominal aortic aneurysms: a systemic review of short-term results. Radiology 2002;10.1148/radio1.2243011675.

31.

Oelschlager

Boyle

Johansen

. Delayed abdominal closure in the management of ruptured abdominal aortic aneurysms. Am J Surg. 1997;173:411–415.

32.

Baily

Shapiro

. Abdominal compartment syndrome. Crit Care. 2000;4:23–29.

33.

May

White

. Repair of abdominal aortic aneurysms by endoluminal method: outcome of the first 100 patients. Med J Aust. 1996;165:549–551.

34.

Blum

Voshage

Lammer

. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med. 1997;336:13–20.

35.

Moritz

Rotermund

Keating

. Infrarenal abdominal aortic aneurysms: implications of CT evaluation of size and configuration for placement of endovascular aortic grafts. Radiology. 1996;198:463–466.

36.

Van Essen

Gussenhoven

van der Lugt

. Accurate assessment of abdominal aortic aneurysm with intravascular ultrasound: validation with computed tomographic angiography. J Vasc Surg. 1999;29:631–638.