Reparação endovascular na rutura aorto‐ilíaca

Introduction

Rupture has a negative impact on abdominal aortic or iliac pathology. Endovascular aneurysm repair (EVAR) is an established treatment in the elective setting which has increasingly been applied in urgent patients and may be associated with a decrease in perioperative mortality.

Objectives

Our primary outcome was perioperative/early mortality. Secondary outcomes include perioperative hemodynamics and procedure‐related complications.

Methods

A prospectively maintained single center database was retrospectively enquired. Patients who underwent rEVAR between March 2008 and March 2014 were included. Rupture was defined as the presence of a retroperitoneal hematoma or extraversion of contrast on a CTA. Although there's no institutional capacity to offer EVAR to all ruptured aneurysms, it is given preference to endovascular repair over open surgery in patients with suitable aortic anatomy for EVAR.

Demographic, perioperative hemodynamics and laboratorial data were assessed. Primary outcome was perioperative/early mortality. Secondary outcomes include procedure‐related and systemic complications.

Results

Forty‐nine patients were included, 43 of whom (88%) were males and mean age was 73.7 ± 10,61 years (range 47 to 90).

Thirty‐five patients presented rAAA (72%) and 9 ruptured iliac aneurysms (18%). Mean aneurysm diameter was 7.6 ± 1.7 cm. Other indications for rEVAR were spontaneous/iatrogenic aortic rupture (6%; n = 3), late aneurysm rupture following EVAR (n = 1) and a case of an anastomotic pseudoaneurysm. Deployed endograft configuration was aortic bi‐iliac in 26 cases (53%), aortic mono‐iliac in 18 (37%) and embolization and endovascular exclusion with iliac branch (10%). Deployed devices were Endurant Medtronic^® in 59%, Excluder Gore^® in 12%, Zenith Cook^® in 22%, Excluder C3 Gore^® in 5%, e Talent Medtronic^® in 2%. 32% were treated under local anesthesia. The 30 dias/intrahospitalar mortality rate was 26.5%, which progressively decreased during the study period. The 30‐day complication rate was local in 20.4%, systemic in 53%. Abdominal compartment syndrome occurred in 10 cases (20.4%), and was found to be a negative prognostic factor. Median hospitalization duration was 7 days (0‐92) and median stay in the intensive care unit was 2 days (0‐65).

Conclusion

EVAR is a valid treatment in the urgent setting for patients with abdominal aortic or iliac rupture. Our results are comparable to the randomized controlled studies