Endovascular Treatment of Acute Aortic Emergencies: Early Results Badr Aljabri, MD, FRCSC King Khalid University Hospital Riyadh, Saudi Arabia
EVAR and Aortic Emergency To evaluate early results of EVAR used in different Aortic Emergencies King Khalid University Hospital, Riyadh
Methods From prospective collected data of consecutive patients with Acute Aortic Emergencies (AAE) treated with EVAR February January 2008
Methods Preoperative multi-planer enhanced computed tomography with 2.5 mm cuts. All done under GA. Stent grafts were introduced through a common femoral artery cut down.
Methods Back-up meier wire Angiography cath through right brachial artery
22 EVAR February January Thoracic 4 Abdominal 1 Hybrid
10 AAE 5 Blunt traumatic thoracic aorta ruptures 4 Ruptured true thoracic aortic aneurysms 1 Ruptured proximal anastomotic aortic psudoaneurysm
Results 13 stent grafts implanted 9 Males : 1 Female mean age of 45 years (22– 73 years) Stent graft diameter mm
Number of patients Number of stents Technical success rate % Left SCA Coverage 30-day mortality rate (%) Complications Blunt Thoracic Rupture Ruptured true thoracic aortic aneurysms (50)1MI Ruptured proximal anastomotic aortic psudoaneurysm 11100NA00 Total (20)1 MI
Results No paraplegia or stoke 1 Access related complication
Case review
Ruptured true thoracic aortic aneurysm 65 year old male patient, HTN Sever back pain No history of trauma Referred with TAA for further management
Ruptured proximal anastomotic aortic psudoaneurysm 52 year old male patient HTN, NIDDM,ESRD on hemodialysis Aorto-bifemoral bypass 6 years ago ACS with left ventricular aneurysm Abdominal pain + pulsatile tender mass Cardiac cath
Blunt traumatic thoracic aorta rupture 23 year old male patient Head-on collusion MVA Multiple fractures both upper and lower limbs and small liver laceration CXR Enhanced CT
17 series 1109 patients 538 (48.5%) TEVAR Significant reduction in Mortality Neurological injury Subgroup analysis
Retrospective review 74 patients 35 open VS 39 TEVAR 30 day mortality 20% surgical group 7.7% TEVAR
30 patients 2 (6.6%) 30-day mortality 1 stroke No paraplegia
Conclusion Endovascular stent graft is an effective treatment option for an acute aortic emergencies particularly those who present with traumatic ruptures. Long-term follow-up is required to confirm its durability
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