Endovascular stent-graft repair of ruptured aortic aneurysms

Purpose: To demonstrate the endovascular approach to the management of ruptured abdominal aortic aneurysms (AAA). Methods: From 1995 to 2001, 24 patients (21 men; mean age 69 years, range 26-92) underwent emergency endovascular treatment for ruptured AAA. The average interval between onset of symptoms and admission to the hospital was 8.0 hours; the mean time between admission and the operation was 2.3 hours. No suprarenal occluding catheter was used. The stent-graft configurations were 19 bifurcated, 4 tube, and 1 aortomonoiliac. Results: Stent-graft placement was successful in 23 (96%) cases. Failed limb extension deployment prompted conversion to open surgery in the remaining patient. One case was converted to open surgery. Mean duration of treatment was 122 minutes. Three (12.5%) patients died in-hospital. The median hospital stay was 12 days. The rate of endoleaks (all type 1) was 16.7%. The overall technical success rate was 77%. The 3-year actuarial survival rate was 75%. Conclusions: Our experience shows excellent results in emergency patients with ruptured AAAs treated with endovascular surgery. In order to verify these promising results, a broader-scale clinical study must be conducted.