Background. Endovascular aneurysm repair (EVAR) has been claimed to decrease periprocedural mortality for treatment of abdominal aortic aneurysms with suspected rupture (rAAA). However the benefit of EVAR in true clinical emergencies (plain ruptured AAA) is still uncertain. This study aimed to analyze immediate and mid term outcomes of true rAAA treated in emergency. Methods. All patients treated for rAAA from 2006 to 2010 were reviewed. Our policy is to perform an immediate computed tomography (CT) in emergency room (ER) for all patients with suspected rAAA. Only patients with evident aneurysm rupture on imaging were selected for this study. EVAR feasibility was left to the discretion of the operative specialized team available 24hours/day. Stability of EVAR repair was assessed with pre-discharge CT-scan. Results. A total of 66 patients with plain rAAA were treated in emergency: 23 underwent EVAR and 43 open surgery. At baseline there was an equal distribution of physiologic characteristics and comorbidities with the exception of age, older in the EVAR group. Intraoperative mortality was 0% in EVAR and 9.3% (4/43) in the open group (p=0.29) while 30-day mortality rates were 21.7%(5/23) vs 34.8%(15/43), respectively (p=0.39). Life table estimates at 6 and 15 months showed survival rates of 54% and 50% after open surgery and of 65% and 58% after EVAR (p=0.19). Endoleak presence was detected on CT in 6 EVAR patients who survived until discharge (none of these required immediate treatment due to small size). Conclusions. Despite the use of EVAR can decrease intraoperative mortality in emergencies for plain rAAA, mortality can involve more than one fifth of these patients at 30-day and one third at six months. The frequent detection of endoleak (more than one fourth of rAAA) at discharge can raise the question whether EVAR might be used as an effective bridge solution for hemodynamic stabilization to be re-evaluated in a later stage. Author Disclosures: P. De Rango: None. M. Lenti: None. E. Cieri: None. F. Verzini: None. G. Simonte: None. P. Bonanno: None. A. Casalino: None. P. Cao: None. Key Words: Abdominal aortic aneurysm • Stent • Emergency care • Vascular surgery • Team
The Fate of Patients Treated in Emergency for True-Ruptured Abdominal Aortic Aneurysms After 30 Days and 6 Months: Is There a Benefit from Endovascular Repair?
CIERI, ENRICO;VERZINI, Fabio;SIMONTE, GIOELE;CAO, Piergiorgio
2011
Abstract
Background. Endovascular aneurysm repair (EVAR) has been claimed to decrease periprocedural mortality for treatment of abdominal aortic aneurysms with suspected rupture (rAAA). However the benefit of EVAR in true clinical emergencies (plain ruptured AAA) is still uncertain. This study aimed to analyze immediate and mid term outcomes of true rAAA treated in emergency. Methods. All patients treated for rAAA from 2006 to 2010 were reviewed. Our policy is to perform an immediate computed tomography (CT) in emergency room (ER) for all patients with suspected rAAA. Only patients with evident aneurysm rupture on imaging were selected for this study. EVAR feasibility was left to the discretion of the operative specialized team available 24hours/day. Stability of EVAR repair was assessed with pre-discharge CT-scan. Results. A total of 66 patients with plain rAAA were treated in emergency: 23 underwent EVAR and 43 open surgery. At baseline there was an equal distribution of physiologic characteristics and comorbidities with the exception of age, older in the EVAR group. Intraoperative mortality was 0% in EVAR and 9.3% (4/43) in the open group (p=0.29) while 30-day mortality rates were 21.7%(5/23) vs 34.8%(15/43), respectively (p=0.39). Life table estimates at 6 and 15 months showed survival rates of 54% and 50% after open surgery and of 65% and 58% after EVAR (p=0.19). Endoleak presence was detected on CT in 6 EVAR patients who survived until discharge (none of these required immediate treatment due to small size). Conclusions. Despite the use of EVAR can decrease intraoperative mortality in emergencies for plain rAAA, mortality can involve more than one fifth of these patients at 30-day and one third at six months. The frequent detection of endoleak (more than one fourth of rAAA) at discharge can raise the question whether EVAR might be used as an effective bridge solution for hemodynamic stabilization to be re-evaluated in a later stage. Author Disclosures: P. De Rango: None. M. Lenti: None. E. Cieri: None. F. Verzini: None. G. Simonte: None. P. Bonanno: None. A. Casalino: None. P. Cao: None. Key Words: Abdominal aortic aneurysm • Stent • Emergency care • Vascular surgery • TeamI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
