Early and Intermediate Outcome of Emergency Endovascular Aneurysm Repair of Ruptured Infrarenal Aortic Aneurysm: A Single-Centre Experience of 90 Consecutive Patients

• Published in: European journal of vascular and endovascular surgery Vol. 37; no. 4; pp. 413 - 419
• Main Authors: Holst, J, Resch, T, Ivancev, K, Björses, K, Dias, N, Lindblad, B, Mathiessen, S, Sonesson, B, Malina, M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2009
• Subjects: Aged; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - therapy; Aortic Rupture - mortality; Aortic Rupture - therapy; Balloon Occlusion; Blood Vessel Prosthesis; Cerebrovascular Disorders - epidemiology; Clinical Medicine; Emergencies; Emergency EVAR; Female; Humans; Kirurgi; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Multivariate Analysis; Outcome; Outcome Assessment (Health Care); Prediction; Prospective Studies; Pulmonary Disease, Chronic Obstructive - epidemiology; Retrospective Studies; Ruptured AAA; Stents; Surgery; Emergency EVAR; Outcome; Ruptured AAA; Prediction
• ISSN: 1078-5884; 1532-2165; 1532-2165
• DOI: 10.1016/j.ejvs.2008.12.015

Abstract Objective To evaluate the early and intermediate outcome of a consecutive series of emergency endovascular aneurysm repairs (eEVAR) of computed tomography (CT)-verified infrarenal ruptured abdominal aortic aneurysm (rAAA) at a single tertiary referral centre. Methods Prospectively collected data of patients operated between April 2000 and October 2007 were retrospectively reviewed and all their pre-, intra- and postoperative imaging were re-evaluated. Patient and procedural data were analysed using a Cox multiregression model. Results Ninety patients (86% men, aged 76 (±7) years), were identified and included in the analysis. Symptom duration was <3 h in 22% of patients, 3–24 h in 39% and >24 h in 39%. Mean aneurysmal diameter was 73 (±14) mm. All patients were treated with the COOK Zenith® stent-graft (56% bi-iliac and 44% uni-iliac). Sixty-one percent were haemodynamically unstable on presentation, and 26% required an intra-operative aortic occlusion balloon to maintain haemodynamic stability. The 30-day and 1-year mortality rates were 27% and 37%, respectively. One-year aneurysm-related mortality was 33%. Twenty-eight percent of patients required re-interventions during the follow-up. The use of an aortic occlusion balloon and the presence of cerebrovascular disease or obstructive lung disorder correlated significantly with 30-day mortality in the multivariate analysis. Conclusion EVAR is a valid treatment option for rAAA when used as a first-line method for all patients.