Meekel Jorn P, van Schaik Theodorus G, van Zeeland Michiel L P, Yeung Kak K, Hoksbergen Arjan W J
Department of Vascular Surgery, Amsterdam University Medical Centres, VU University Medical Center, Amsterdam, the Netherlands.
Amsterdam Cardiovascular Sciences, Department of Physiology, Amsterdam University Medical Centres, Location VU University Medical Center, Amsterdam, the Netherlands.
EJVES Short Rep. 2019 Jan 21;42:15-17. doi: 10.1016/j.ejvssr.2018.12.001. eCollection 2019.
Ruptured abdominal aortic aneurysms (AAAs) are known to be associated with high fatal outcomes. Giant AAAs are often defined as having a maximum diameter over 13 cm. Large AAAs over 8 cm have demonstrated a yearly rupture rate of 30-50%, which explains the rarity of giant AAAs. Endovascular repair of ruptured AAAs (rAAAs) is increasingly advocated because of the shorter hospital stay and fewer post-operative complications. Nonetheless, outcomes regarding mortality and cost-effectiveness show a large variability and long-term outcomes are lacking. Few data have been published on treatment of giant AAAs and rAAAs; however, open surgery is generally the preferred option.
An 83 year old presented to the Emergency Department with a history of ruptured abdominal aortic aneurysm treated with an aorto-uni-iliac endograft and a femorofemoral crossover bypass. During follow up, this was complicated by a symptomatic type III endoleak, which was treated by endovascular repair. During the current admission, he presented with a re-rupture of his former aneurysm, which now was 18 cm diameter because of a type IA endoleak. Open surgical repair was performed and the post-operative course was without complications.
The current case underlines the value of vascular surgeons being able to perform both open and endovascular surgery in rAAA.
已知腹主动脉瘤破裂（AAA）与高致死率相关。巨大腹主动脉瘤通常定义为最大直径超过13厘米。直径超过8厘米的大型腹主动脉瘤年破裂率为30% - 50%，这解释了巨大腹主动脉瘤为何罕见。由于住院时间短且术后并发症少，越来越多的人主张对破裂腹主动脉瘤（rAAA）进行血管内修复。尽管如此，死亡率和成本效益方面的结果差异很大，且缺乏长期结果。关于巨大腹主动脉瘤和破裂腹主动脉瘤治疗的报道很少；然而，开放手术通常是首选方案。
一名83岁患者因腹主动脉瘤破裂病史就诊于急诊科，接受了主动脉单髂内支架植入术和股股交叉旁路移植术治疗。随访期间，出现有症状的III型内漏并发症，通过血管内修复进行了治疗。在本次入院期间，他出现了先前动脉瘤的再次破裂，由于IA型内漏，此时动脉瘤直径达18厘米。进行了开放手术修复，术后过程无并发症。
本病例强调了血管外科医生能够对破裂腹主动脉瘤同时进行开放手术和血管内手术的价值。
