Delalieux S, Hendriks J M H, Lauwers P, Schwagten V, Jorens Ph, d'Archambeau O, Van der Zijden Th, Hertoghs M, Van Schil P E Y
Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium.
Acta Chir Belg. 2010 May-Jun;110(3):272-4. doi: 10.1080/00015458.2010.11680616.
Emergency endovascular aneurysm repair (eEVAR) for ruptured abdominal aortic aneurysms (rAAA) is still under investigation. Since installation of an urgent eEVAR kit in our hospital, all patients with a rAAA or urgent thoracic aortic aneurysm are candidates for eEVAR or eTEVAR (emergency thoracic EVAR), respectively. For this study, we analyzed all rAAA patients treated with eEVAR.
Data were recorded prospectively. Criteria for an eEVAR were an infrarenal neck > or = 15 mm, acceptable landing zone, angles below 70 degrees and a good femoral approach. We prefer preoperative angio CT-scan but in case of instability, an intra-aortic balloon can stabilize the patient during angiography (in the OR) to decide between open or eEVAR repair. Follow-up was performed on regular intervals by duplex or CT-scan. Thirty-day mortality and overall survival were calculated.
Since 2006, nine male rAAA patients with a mean age of 73 years (range : 62-82) had eEVAR repair. Aneurysm diameter was 8 cm (range : 5.8-11). The Hardman index was 1.5 (range : 0-3). In eight patients an aorto-uni-iliac device was placed succesfully followed by a femorofemoral crossover bypass. The 30-day operative mortality was 12.5% (one patient with septic shock). Three patients showed a type 2 endoleak with stable diameter during follow-up but one patient showed expansion 4 years after treatment.
Treating rAAA with eEVAR in selected patients with acceptable anatomy and a kit permanently available in the operating room yielded good results by a surgical team trained for both open and eEVAR repair. The conversion rate was low (11%) and the survival (immediate and 30-days) was excellent (87.5%).
腹主动脉瘤破裂（rAAA）的急诊血管内动脉瘤修复术（eEVAR）仍在研究中。自我院安装紧急eEVAR套件以来，所有rAAA患者或紧急胸主动脉瘤患者分别成为eEVAR或eTEVAR（急诊胸主动脉腔内修复术）的候选对象。在本研究中，我们分析了所有接受eEVAR治疗的rAAA患者。
前瞻性记录数据。eEVAR的标准为肾下颈部≥15mm、合适的锚定区、角度低于70度以及良好的股动脉入路。我们更倾向于术前血管造影CT扫描，但如果患者情况不稳定，可在血管造影期间（在手术室）使用主动脉内球囊稳定患者，以决定采用开放修复还是eEVAR修复。通过双功超声或CT扫描定期进行随访。计算30天死亡率和总生存率。
自2006年以来，9例平均年龄73岁（范围：62 - 82岁）的男性rAAA患者接受了eEVAR修复。动脉瘤直径为8cm（范围：5.8 - 11cm）。哈德曼指数为1.5（范围：0 - 3）。8例患者成功植入了主动脉单髂动脉装置，随后进行了股股交叉旁路移植术。30天手术死亡率为12.5%（1例患者发生感染性休克）。3例患者在随访期间出现2型内漏，瘤体直径稳定，但1例患者在治疗4年后出现瘤体增大。
对于解剖结构合适且手术室常备套件的特定患者，由接受过开放手术和eEVAR修复培训的手术团队采用eEVAR治疗rAAA可取得良好效果。转化率较低（11%），即刻和30天生存率良好（87.5%）。
