Document Detail


Endovascular treatment of ruptured abdominal aortic aneurysms: a shift of the paradigm?
MedLine Citation:
PMID:  16212454     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA) to the results with open surgery. METHODS: Between May 2001 and January 2004, 50 patients were diagnosed with rAAA. Fifteen (30%) patients (14 men; median age 73 years, range 58-85) underwent EVAR, while 26 (52%) patients (23 men; median age 75 years, range 60-84) had open surgery. Nine (18%) patients (5 men; median age 86 years, range 77-91) were not operated upon. Circulatory shock was defined as systolic blood pressure<80 mmHg. Mortality was defined as death within 30 days after operation; in cases where hospital stay exceeded 30 days, in-hospital mortality was registered. Five risk factors (age>76 years, loss of consciousness, hemoglobin<90 g/L, creatinine>190 micromol/L, and electrocardiographic ischemia) were analyzed. RESULTS: In the EVAR group, 93% (14/15) of the aneurysms were excluded from the bloodstream; there were 2 (13%) conversions: 1 intraoperatively for stent-graft migration and another owing to dissection prior to hospital discharge. Mortality after open surgery was 46% (12/26) versus 13% (2/15) in the EVAR group (p>0.05). Univariate analysis without considering variables other than mortality resulted in OR 5.4 (95% CI 0.9 to 58; p=0.07). Considering risk factors and shock, multivariate analysis resulted in OR 6.5 (95% CI 0.8 to 96; p=0.08). In the EVAR group, 60% (9/15) had complications; in the group with open surgery, the complication rate was 85% (22/26; p=0.13). CONCLUSIONS: It is possible to treat rAAA with EVAR. Hypotensive patients can, at least initially, be operated under local anesthesia to stabilize blood pressure utilizing a percutaneously inserted occlusion balloon. There was a trend in our study for reduced mortality and morbidity with EVAR, but further studies are required to conclude whether EVAR significantly increases survival and reduces complications.
Authors:
Thomas Larzon; Rickard Lindgren; Lars Norgren
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  12     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-11     Completed Date:  2006-02-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  548-55     Citation Subset:  IM    
Affiliation:
Department of Surgery, Orebro University Hospital, Orebro, Sweden. thomas.larzon@orebroll.se
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / epidemiology,  radiography,  surgery*
Aortic Rupture / epidemiology,  radiography,  surgery*
Female
Hospital Mortality
Humans
Length of Stay
Male
Middle Aged
Morbidity
Multivariate Analysis
Postoperative Complications / etiology,  mortality,  radiography
Retrospective Studies
Risk Factors
Sweden / epidemiology
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures*

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


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