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Title: Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

Abstract

Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a goodmore » option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.« less

Authors:
; ; ;  [1]; ;  [2];  [3];  [1]
  1. University of Insubria, Vascular and Interventional Radiology, Department of Radiology (Italy)
  2. University of Insubria, Department of Vascular Surgery (Italy)
  3. University of Insubria, Department of Anesthesiology (Italy)
Publication Date:
OSTI Identifier:
21091243
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 29; Journal Issue: 2; Other Information: DOI: 10.1007/s00270-005-0080-6; Copyright (c) 2006 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCIDENTS; ANATOMY; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; BYPASSES; CREATININE; GRAFTS; LEGS; PATIENTS; REPAIR; SURGERY; WOUNDS

Citation Formats

Lagana, Domenico, E-mail: monica.mangini@tin.it, Carrafiello, Gianpaolo, Mangini, Monica, Fontana, Federico, Caronno, Roberto, Castelli, Patrizio, Cuffari, Salvatore, and Fugazzola, Carlo. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results. United States: N. p., 2006. Web. doi:10.1007/S00270-005-0080-6.
Lagana, Domenico, E-mail: monica.mangini@tin.it, Carrafiello, Gianpaolo, Mangini, Monica, Fontana, Federico, Caronno, Roberto, Castelli, Patrizio, Cuffari, Salvatore, & Fugazzola, Carlo. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results. United States. doi:10.1007/S00270-005-0080-6.
Lagana, Domenico, E-mail: monica.mangini@tin.it, Carrafiello, Gianpaolo, Mangini, Monica, Fontana, Federico, Caronno, Roberto, Castelli, Patrizio, Cuffari, Salvatore, and Fugazzola, Carlo. Sat . "Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results". United States. doi:10.1007/S00270-005-0080-6.
@article{osti_21091243,
title = {Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results},
author = {Lagana, Domenico, E-mail: monica.mangini@tin.it and Carrafiello, Gianpaolo and Mangini, Monica and Fontana, Federico and Caronno, Roberto and Castelli, Patrizio and Cuffari, Salvatore and Fugazzola, Carlo},
abstractNote = {Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.},
doi = {10.1007/S00270-005-0080-6},
journal = {Cardiovascular and Interventional Radiology},
number = 2,
volume = 29,
place = {United States},
year = {Sat Apr 15 00:00:00 EDT 2006},
month = {Sat Apr 15 00:00:00 EDT 2006}
}