Endovascular treatment for ruptured abdominal aortic aneurysms

Aim. The authors report the results of their retrospective study comparing the outcome for the different endograft configuration. Methods. Only patients with a ruptured abdominal aortic aneurysm (rAAA) confirmed by contrast enhanced computed-tomography-angiography (CTA) were eligible for the analysis. Out of a group of 67 patients, 42 patients (62.7%) were treated with endograft (EG). Patients were divided for comparative analysis according to the configuration of the EG implanted. Twenty-five patients (59.5%) were operated on general anesthesia and orotracheal intubation. Thirteen patients (30.9%) received an aorto-uni-iliac (AUI) EG (group A), and 29 a bifurcated EG (group B). Data base included 29 variables (18 preoperative, 8 intraoperative, 3 postoperative). Results. Primary technical success rate was 95% (40/42). No patient required conversion to open repair. Overall, a total of 12 patients (28.5%) died within 30 days: there were 2 intraoperative deaths (4.7%), 9 patients died within 48 hours of operation, 3 further patients within two weeks. Hospitalization death rate was 30.9% (13/42). At univariate and multivariate analyses, the subgroups were well-matched for gender, age, aneurysm size and morphology, type of diagnosis, delay, and values of the parameters at admission; shock was statistically more frequent in the group A. Hospital mortality was statistically higher in group A; type of EG and intensive care unit admission were the only independent predictors of hospital mortality. Conclusion. In the authors' experience, a higher mortality rate for the AUI configuration was observed; shock at admission was confirmed the most important factor for postoperative survival.