Original Scientific ArticlesEndovascular graft repair of ruptured aortoiliac aneurysms1☆,
Section snippets
Patients
Between 1993 and 1998, 47 ruptured AIAs were treated at the Montefiore Medical Center, of which 12 were treated using one of two types of EVGs. Nine of these patients were male and three were female. Ages ranged from 40 to 86 years (mean 72 years). The types and locations of the aneurysms included six AAAs (four true, two false) and six iliac artery aneurysms (two true, four false)(Table 1). Spiral CT scan was performed in each patient. All 12 patients were deemed prohibitively high risk for
Results
The interval between the onset of symptoms and initiation of the procedure and other operative data are shown in Table 2. Although nine patients showed signs of hypotension during the preoperative period, four patients became hemodynamically stable either with or without fluid resuscitation and were able to tolerate the relatively long interval between symptom onset and operation. In those patients who required relatively rapid arterial control because of sustained hemodynamic instability,
Discussion
During the last 4 decades, important advances have been made in the treatment of ruptured AAAs or iliac artery aneurysms.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Despite these efforts, operative mortality rates have remained high. Most of these advances in the management of ruptured aneurysms have focused on the nonsurgical aspects of care, with little change in the surgical treatment methods. We evaluated the feasibility and safety of EVG repair in the treatment of ruptured AAAs
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Cited by (144)
A Comparison of the Short-Term Outcomes After use of Aorto-Uni-Iliac Versus Bifurcated Endografts for Endovascular Repair of Ruptured Abdominal Aortic Aneurysms
2023, Annals of Vascular SurgeryCitation Excerpt :Open surgical repair with synthetic graft interposition used to be the standard of care in this clinical situation. Endovascular aneurysm repair (EVAR) has become the most performed procedure for rAAA due to lower mortality compared to open repair.1 The procedure has been independently associated with a lower mortality risk than open surgical repair in AAA patients with rupture.2,3
Endovascular Aneurysm Repair–First Strategy for Ruptured Aneurysm Focuses on Fitzgerald Classification and Vein Thrombosis
2018, Annals of Vascular SurgeryTransition from Open Surgery to Endovascular Treatment of Abdominal Aortic Aneurysm Rupture
2016, Annals of Vascular SurgeryCitation Excerpt :A meta-analysis of the last 50 years experience demonstrated that open surgical repair (OSR) continues to be related with high mortality7 despite the evolution of anesthesia and intensive care.8,9 Since the 90s, when the use of endovascular repair (EVAR) was first reported for rAAA treatment,10–12 there has been conflicting evidence on EVAR advantages over OSR-regarding mortality rates.13–16 Unlike some reports that have shown reduced mortality with EVAR,17,18 randomized studies which were expected to provide a more solid evidence failed to show similar results.19–22
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2016, Managing Medical Devices within a Regulatory FrameworkClinical application and early outcomes of the aortouni-iliac configuration for endovascular aneurysm repair
2014, Journal of Vascular SurgeryCitation Excerpt :The favorable results reported from this retrospective review suggest that the AUI configuration is a valid option for patients with complex aortoiliac anatomy and may be preferable to open repair when a BIF graft cannot be deployed. In addition, the technical ease of deploying a one-sided device compared with a complicated BIF modular approach should not be underemphasized, especially in urgent clinical scenarios including ruptured aneurysms.17 As with all EVAR patients, follow-up is essential to monitor graft complications.
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Supported by grants from the U.S. Public Health Service (HL 02990-04), the James Hilton Manning and Emma Austin Manning Foundation, the Anne S Brown Trust, and Jikei University International Research Grant.
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No competing interests declared.