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Endovascular Repair of Ruptured Abdominal Aortoiliac Aneurysms RAAAs...

It is generally accepted that despite all therapeutic improvements, open surgical treatment of ruptured abdominal aortoiliac aneurysms (RAAAs) has a high mortality, according to data presented in New York today at the 33rd annual VEITHsymposium's8482;.



Frank J. Veith, MD, Professor of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and The William J. von Liebig Chair in Vascular Surgery at Cleveland Clinic (Cleveland, OH) said that several centers reported that endovascular techniques, including the use of aortic endografts, have reduced the 30-day mortality of treatment for RAAAs to 10-18%.



Centers cited in the study include Malmö University Hospital (Malmö, Sweden), University Medical Center Groningen (Groningen, The Netherlands) and University Hospital Zurich (Zurich, Switzerland).    




Veith reported that strategies, adjuncts and techniques used to help to reduce mortality include ensuring certain steps are taken, such as hypotensive hemostasis, or restriction of fluid resuscitation; placement, preferably via a femoral approach under local anesthesia, of a guidewire and catheter in the supraceliac aorta. Using this catheter, arteriography is performed to define infrarenal aortic neck and iliac anatomy and to determine suitability for endovascular graft repair of the aneurysms using either an aorto-unilateral graft or a bifurcated modular graft); in the event that circulatory arrest or collapse (BP < 40 mm Hg) occurs, a large (14-16 Fr) hemostatic sheath is placed via one femoral artery into the supraceliac aorta; a large compliant balloon is inserted through this sheath and inflated with dilute contrast under fluoroscopic control to occlude the supraceliac aorta; an aortic endograft is then deployed via the opposite femoral artery while the inflated supraceliac balloon is left in place.



After the main body of the graft is fully deployed, a second balloon is placed within the body of the graft and inflated. The supraceliac balloon is deflated and removed, and the remainder of the operation is completed.



If abdominal compartment syndrome is suspected, minilaparotomy is performed with evacuation of the retroperitoneal hematoma.    




Dr. Veith concluded, Use of these methods and techniques may contribute to improved survival with endograft treatment of RAAAs.



About VEITHsymposium's8482;

Now in its fourth decade, VEITHsymposium's8482; provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features 300 rapid-fire presentations from world-renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.

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