Document Detail


Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms.
MedLine Citation:
PMID:  10998645     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To report a new management approach for the treatment of ruptured aortoiliac aneurysms.
METHODS: This approach includes hypotensive hemostasis, minimizing fluid resuscitation, and allowing the systolic blood pressure to fall to 50 mmHg. Under local anesthesia, a transbrachial guidewire was placed under fluoroscopic control in the supraceliac aorta. A 40-mm balloon catheter was inserted over this guidewire and inflated only if the blood pressure was less than 50 mmHg, before or after the induction of anesthesia. Fluoroscopic angiography was used to determine the suitability for endovascular graft repair. When possible, a prepared, "one-size-fits-most" endovascular aortounifemoral stented PTFE graft was used, combined with occlusion of the contralateral common iliac artery and femorofemoral bypass. If the patient's anatomy was unsuitable for endovascular graft repair, standard open repair was performed using proximal balloon control as needed.
RESULTS: Twenty-five patients with ruptured aortoiliac aneurysms (18 aortic, 7 iliac) were managed using this approach. Balloon inflation for proximal control was required in nine of the 25 patients. Twenty patients were treated with endovascular grafts. Five patients required open repair. The ruptured aneurysm was excluded in all 25 patients; 23 survived. Two deaths occurred in patients who received endovascular grafts with serious comorbidities. The surviving patients who received endovascular grafts had a median hospital stay of 6 days, and the preoperative symptoms resolved in all patients.
CONCLUSIONS: Hypotensive hemostasis is usually an effective means to provide time for balloon placement and often for endovascular graft insertion. With appropriate preparation and planning, many if not most patients with ruptured aneurysms can be treated by endovascular grafts. Proximal balloon control is not required often but may, when needed, be an invaluable adjunct to both endovascular graft and open repairs. The use of endovascular grafts and this approach using other image-guided catheter-based adjuncts appear to improve treatment outcomes for patients with ruptured aortoiliac aneurysms.
Authors:
T Ohki; F J Veith
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Annals of surgery     Volume:  232     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-27     Completed Date:  2000-10-27     Revised Date:  2013-06-11    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  466-79     Citation Subset:  AIM; IM    
Affiliation:
Division of Vascular Surgery, Department of Surgery, Montefiore Medical Center, New York, New York 10467, USA. takohki@msn.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, Ruptured / mortality,  surgery*
Aortic Aneurysm, Abdominal / mortality,  surgery*
Aortic Rupture / mortality,  surgery*
Balloon Occlusion*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / methods*
Equipment Design
Female
Hemostasis, Surgical / methods
Humans
Iliac Aneurysm / mortality,  surgery*
Length of Stay
Male
Polytetrafluoroethylene
Grant Support
ID/Acronym/Agency:
HL 02990/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9002-84-0/Polytetrafluoroethylene
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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