Department of Vascular Surgery, General Hospital of PLA, Beijing 100853, China.
Chin Med J (Engl). 2009 Aug 5;122(15):1728-31.
As an alternative to open aneurysm repair, endovascular aortic repair (EVAR) has been applied to ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.
From July 1997 to September 2007, 20 men and six women with rAAA (median age, 68 years) were treated with EVAR. Most patients with suspected rAAA underwent emergency computed tomographic angiography (CTA). The procedure was performed under general or local anesthesia. Endovascular clamping was attempted in hemodynamically unstable patients. Bifurcated endografts and aorto-uni-iliac (AUI) endografts with crossover bypass were used. Patients had CT scan prior to discharge, 3, 6, 12 months after discharge, and annually thereafter.
Time between diagnosis and EVAR ranged from 1 hour to 5 days. EVAR was performed under general anesthesia in 21 patients, and under local anesthesia in five patients. Endovascular aortic clamping was performed in four patients. There was no conversion to open surgery during EVAR. Stent-graft insertion was successful in all patients. One patient died during EVAR from acute myocardial infarction. Ten patients had systolic blood pressure < 80 mm Hg. Eleven patients received a blood transfusion. Mean aneurysm size was (47 +/- 12) mm. Mean ICU stay was (8 +/- 3) days, mean hospital stay (18+/- 6) days, and mean procedure time (120 +/- 32) minutes. The 30-day mortality was 23% (6/26 patients), and major morbidity 35% (9/26 patients). Early endoleak occurred in 8/26 patients (31%). The mean follow-up was (18 +/- 7) months. No patient demonstrated migration of the stent-graft.
EVAR is a safe and effective option for treatment of acute rAAA, independent of the patient's general condition. Immediate and mid-term outcomes are favorable, but long-term outcome is unknown. Multi-center studies are necessary to establish the role of EVAR for rAAA.
作为开放动脉瘤修复的替代方法，血管内主动脉修复（EVAR）已应用于破裂性腹主动脉瘤（rAAA）。本研究旨在评估 EVAR 治疗 rAAA 的即刻和长期结果。
1997 年 7 月至 2007 年 9 月，20 名男性和 6 名女性 rAAA 患者（中位年龄 68 岁）接受了 EVAR 治疗。大多数疑似 rAAA 的患者均接受了紧急计算机断层血管造影（CTA）检查。该手术在全身麻醉或局部麻醉下进行。对血流动力学不稳定的患者尝试进行血管内夹闭。使用分叉式内支架和带交叉旁路的主动脉-单-髂内（AUI）内支架。患者在出院前、出院后 3、6、12 个月以及此后每年进行 CT 扫描。
从诊断到 EVAR 的时间为 1 小时至 5 天。21 例患者在全身麻醉下进行 EVAR，5 例患者在局部麻醉下进行。4 例患者行血管内主动脉夹闭。EVAR 过程中无中转开放手术。所有患者的支架置入均成功。1 例患者在 EVAR 期间因急性心肌梗死死亡。10 例患者收缩压<80mmHg。11 例患者输血。平均动脉瘤大小为（47±12）mm。平均 ICU 住院时间为（8±3）天，平均住院时间为（18±6）天，平均手术时间为（120±32）分钟。30 天死亡率为 23%（26 例患者中的 6 例），主要发病率为 35%（26 例患者中的 9 例）。8/26 例（31%）患者出现早期内漏。平均随访时间为（18±7）个月。无患者支架移位。
EVAR 是治疗急性 rAAA 的一种安全有效的选择，与患者的一般情况无关。即刻和中期结果良好，但长期结果未知。有必要开展多中心研究以确定 EVAR 在 rAAA 中的作用。
