Print this pageHow often are ruptured abdominal aortic aneurysms suitable for endovascular repair?
Back to Annual MeetingBack to Program
Manish Mehta, MD, John B. Taggart, MD, Stephanie Saltzberg, MD, Paul B. Kreienberg, MD, Sean P. Roddy, MD, Philip Sk Paty, MD, Yaron Sternbach, MD, Kathleen J. Ozsvath, MD, Dhiraj M. Shah, MD, R. Clement Darling, III, MD.
Albany Medical College, Albany, NY, USA.
Purpose: To determine anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for endovascular aneurysm repair (EVAR).
Methods: Aneurysm morphology was evaluated by comparing CTA of patients presenting with ruptured and non-ruptured AAA for potential treatment with any of the currently available stentgrafts. Fifty consecutive patients with ruptured AAA and a preoperative CTA were analyzed for the following characteristics: 1) aneurysm neck length, diameter, calcifications, angulations, thrombus, 2) iliac artery stenosis, tortuosity, calcifications, and 3) aneurysm size, and compared to another 50 consecutive CTA of non-ruptured AAA. Endovascular anatomical exclusion criteria for ruptured AAA was modified and included aortic neck length of ≥10mm, aortic neck diameter ≤ 32mm, aortic neck angulation ≤ 75º, and exclusion criteria included bilateral iliac artery diameter ≤5 mm with significant calcifications.
Results: Using these modified criteria (Table), 80% of these patients presenting with ruptured AAA underwent successful EVAR. Over a mean follow-up of 29 months, 6 (15%) patients required adjunctive procedures; 3 proximal and distal stentgraft extension for endoleak, 2 proximal aortic neck Palmaz stent placement for endoleak, and 1 elective conversion to open surgical repair.
Ruptured AAA
Non-Ruptured AAA
N
50
50
Male / female
36 / 14
41 / 9
AAA size (mean, range)
6.4 cm, 4.5 - 9.5 cm
5.6 cm, 4.5 - 8.9 cm
Aortic neck diameter >32
3 (6%)
5 (10%)
Aortic neck length < 10mm
4 (8%)
5 (10%)
Bilateral EIA < 6mm with sig. Calcifications
1 (2%)
2 (4%)
Aortic neck angulation > 75°
2 (4%)
3 (6%)
Mean aortic neck length
18 mm
20 mm
Mean aortic neck diameter
24 mm
24 mm
Mean EIA diameter
8 mm
9 mm
Conclusion: Similar to elective AAA, up to 80% of patients with ruptured AAA could be anatomically suitable for EVAR. Using a modified inclusion criteria, EVAR can be offered to most patients presenting emergently with ruptured AAA. Secondary re-interventions might be necessary in up to 15% of patients, and unsuitable aortic neck morphology is the primary reason for exclusion from EVAR.
Back to Annual Meeting
Back to Program
Read the Privacy Policy.