de Bruin Jorg L, Brownrigg Jack R W, Karthikesalingam Alan, Patterson Benjamin O, Holt Peter J E, Hinchliffe Robert J, Morgan Robert A, Loftus Ian M, Thompson Matthew M
St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK
St George's Vascular Institute, St George's University Hospitals NHS Foundation Trust, London, UK.
J Endovasc Ther. 2015 Jun;22(3):283-7. doi: 10.1177/1526602815582529. Epub 2015 Apr 22.
To assess the feasibility and report preliminary results of ruptured abdominal aortic aneurysm (rAAA) repair with endovascular aneurysm sealing (EVAS), a novel therapeutic alternative whose feasibility has not been established in rAAAs due to the unknown effects of the rupture site on the ability to achieve sealing.
Between December 2013 and April 2014, 5 patients (median age 71 years, range 57-90; 3 men) with rAAAs were treated with the Nellix EVAS system at a single institution. Median aneurysm diameter was 70 mm (range 67-91). Aneurysm morphology in 4 of the 5 patients was noncompliant with instructions for use (IFU) for both EVAS and standard stent-grafts; the remaining patient was outside the IFU for standard stent-grafts but treated with EVAS under standard IFU for the Nellix system. Median Hardman index was 2 (range 0-3). Two patients died of multiorgan failure after re-laparotomy and intraoperative cardiac arrest, respectively. Among survivors, all devices were patent with no signs of endoleak or failed aneurysm sac sealing at 6 months (median follow-up 9.2 months).
EVAS for the management of infrarenal rAAAs appears feasible. The use of EVAS in emergency repairs may broaden the selection criteria of the current endovascular strategy to include patients with more complex aneurysm morphology.
评估采用血管腔内动脉瘤封闭术（EVAS）修复破裂腹主动脉瘤（rAAA）的可行性并报告初步结果。EVAS是一种新型治疗方法，由于破裂部位对实现封闭能力的影响未知，其在rAAA中的可行性尚未确立。
2013年12月至2014年4月期间，一家机构对5例rAAA患者（年龄中位数71岁，范围57 - 90岁；3例男性）采用Nellix EVAS系统进行治疗。动脉瘤直径中位数为70 mm（范围67 - 91）。5例患者中有4例的动脉瘤形态不符合EVAS和标准覆膜支架的使用说明（IFU）；其余1例患者不符合标准覆膜支架的IFU，但在Nellix系统的标准IFU下接受了EVAS治疗。Hardman指数中位数为2（范围0 - 3）。2例患者分别在再次剖腹手术和术中心脏骤停后死于多器官功能衰竭。在幸存者中，所有装置均通畅，6个月时无内漏迹象或动脉瘤囊封闭失败（随访中位数9.2个月）。
EVAS用于治疗肾下腹主动脉瘤似乎可行。在急诊修复中使用EVAS可能会拓宽当前血管腔内治疗策略的选择标准，以纳入动脉瘤形态更复杂的患者。
