Endovascular Repair of Ruptured Aortic Aneurysm: A Single-Center Experience.

Uygar Çağdaş Yüksel, Serkan Asil, Erkan Yıldırım, Mehmet Sadık Karpat, Suat Görmel, Serdar Fırtına, Salim Yaşar, Barış Buğan, Ayşe Saatçi Yaşar, Murat Çelik, Cengiz Bolcal, Cem Barçın
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Abstract

Objective: Aortic rupture is a rare and catastrophic emergency. Prompt diagnosis and treatment are the primary determinants of mortality. During follow-up, the majority of patients who have been effectively treated die from hypovolemic shock and multiorgan failure. This article describes the clinical and procedural details of sixteen patients with ruptured aortic aneurysms treated endovascularly. In addition, it discusses the main factors contributing to the mortality of these patients.

Method: Patients who underwent endovascular treatment for acute aortic rupture at our center from October 2016 to March 2023 were included in this retrospective study.

Results: A total of 16 patients underwent endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) for acute aortic rupture. The patients' mean age was 73.06 years (range: 52-92), and 15 of them were male. The ruptures occurred in the abdominal aortic aneurysm in ten patients, in thoracic aortic aneurysm in three patients, in the isolated iliac artery aneurysm in two patients, and there was one case of non-aneurysmal aortic rupture. In our series, patients who presented with an impending, self-limited rupture and stable hemodynamic status had good prognostic outcomes. However, eight patients died due to multiorgan failure, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, or abdominal compartment syndrome. These patients generally had poor admission vital signs and low hemoglobin values. The most critical determinants for the success of the procedure are promptly stopping the bleeding, avoiding general anesthesia, and opting for blood product replacement instead of fluid replacement.

Conclusion: Each patient with ruptured aortic aneurysm should be managed according to the patient's hemodynamics at presentation, the size of the aneurysm, the suitability for percutaneous procedure, logistical factors, and the operator-center's experience.

主动脉瘤破裂的血管内修复:单中心经验
目的:主动脉破裂是一种罕见的灾难性急症:主动脉破裂是一种罕见的灾难性急症。及时诊断和治疗是决定死亡率的主要因素。在随访期间,大多数得到有效治疗的患者死于低血容量性休克和多器官功能衰竭。本文描述了 16 名主动脉瘤破裂患者接受血管内治疗的临床和手术细节。此外,文章还讨论了导致这些患者死亡的主要因素:这项回顾性研究纳入了 2016 年 10 月至 2023 年 3 月期间在本中心接受血管内治疗的急性主动脉破裂患者:共有16名患者因急性主动脉破裂接受了血管内动脉瘤修补术(EVAR)或胸腔内动脉瘤修补术(TEVAR)。患者的平均年龄为 73.06 岁(52-92 岁),其中 15 人为男性。10例患者的破裂发生在腹主动脉瘤,3例患者的破裂发生在胸主动脉瘤,2例患者的破裂发生在孤立的髂动脉瘤,还有1例非动脉瘤主动脉破裂。在我们的系列研究中,即将发生自限性破裂且血流动力学状态稳定的患者预后良好。然而,有八名患者因多器官功能衰竭、失血性休克、弥散性血管内凝血病、肾功能衰竭或腹腔隔室综合征而死亡。这些患者通常入院时生命体征较差,血红蛋白值较低。手术成功与否的最关键因素是及时止血、避免全身麻醉以及选择血液制品替代液体替代品:结论:每位主动脉瘤破裂患者都应根据其发病时的血流动力学情况、动脉瘤的大小、是否适合经皮手术、后勤因素以及操作中心的经验进行管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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