Endovascular Aneurysm Repair-First Strategy for Ruptured Aneurysm Focuses on Fitzgerald Classification and Vein Thrombosis.

Abstract

BACKGROUND:

Recent study have demonstrated the good results of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (RAAAs). We report on the results of our EVAR-first strategy for RAAAs focuses on Fitzgerald (F) classification and vein thrombosis.

MATERIALS AND METHODS:

From 2011 to 2017, 31 patients with RAAA underwent EVAR at our hospital. We compared F-1 patients (group A) with F-2 to F-4 patients with obvious retroperitoneal hematoma (group B).

RESULTS:

The baseline characteristics in group A (n = 9) and group B (n = 22) were similar. In group B, there were 8 cases of F-2, 10 cases of F-3, and 4 cases of F-4. Of the 22 cases in group B, 16 (73%) cases involved preoperative shock. Operation time was not significantly different (group A: 147 min and group B: 131 min, P = 0.48). The total mortality rate of group A and group B combined was 77.4%. The 30-day mortality was 0% for group A and 23.8% for group B, in which there were 2 F-4 cases and 3 F-3 cases. In group B, hematoma-related complications developed in 6 cases (deep vein thrombosis: 4 cases, abdominal compartment syndrome: 1 case, and hematoma infection: 1 case), and 1 case with deep vein thrombosis developed a pulmonary embolism that resulted in cardiac arrest. The 3-year survival rate was significantly higher for group A (100% vs. 52.3%, P = 0.016), but the freedom from aortic death rate was not significantly different (100% vs. 66.7%, P = 0.056).

CONCLUSIONS:

Using EVAR for RAAA is a valid strategy. Certain complications that are associated with peritoneal hematoma, especially venous thrombosis, should receive particular attention.

• Authors: Yuri Murakami, Naoki Toya, Soichiro Fukushima, Eisaku Ito, Tadashi Akiba, Takao Ohki
• Journal: Annals of vascular surgery (Ann Vasc Surg) Vol. 52 Pg. 36-40 (Oct 2018) ISSN: 1615-5947 [Electronic] Netherlands
• PMID: 29778613 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Aged
• Aortic Aneurysm, Abdominal (complications, diagnostic imaging, mortality, surgery)
• Aortic Rupture (complications, diagnostic imaging, mortality, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects, mortality)
• Endovascular Procedures (adverse effects, mortality)
• Female
• Hematoma (etiology)
• Humans
• Male
• Retroperitoneal Space
• Risk Factors
• Treatment Outcome
• Venous Thrombosis (diagnostic imaging, etiology)