Endovascular Repair of Ruptured Aneurysms

Minimally invasive endovascular repair of ruptured aortic aneurysms is increasingly common and avoids many of the risks of surgical repair, according to data presented at the annual International Symposium on Endovascular Therapy in Miami Beach (FL, USA) in January 2005.

Most ruptured aortic aneurysms, known as abdominal aortic aneurysms (AAAs), begin with a weakened area in the wall of the aorta. Over time, the pressure of circulating blood can cause the weakened area to swell, like a balloon. As the size increases and the walls of the aorta become thinner, the chance of rupture grows. On average, about 40-50% of patients who have open surgery for a ruptured aortic aneurysm die. Sometimes, a doctor will recommend that the balloon be electively repaired before it ruptures. About 5% of patients undergoing elective surgery die, and about 2% die during elective endovascular repair. A ruptured aortic aneurysm is an emergency and urgent treatment is necessary but much riskier.

Data were presented at the symposium on 476 patients who received endovascular repair for burst aneurysms, of whom 19% (91) died and 81% survived. This is in contrast to the 40-50% of patients who die following surgery for a ruptured aortic aneurysm. Endovascular repair involves threading a device called an endograft through a blood vessel in the groin and into the aorta. The flow of blood is redirected through the graft so the pressure on the aneurysm is relieved. As this therapy has become more popular, more options and sizes of endografts have become available, so obtaining the appropriate size in an emergency is no longer a concern.

"Minimally invasive endovascular repair of the rupture avoids many of the dangers of surgery,” commented Frank J. Veith, M.D., professor and vice chairman of the department of surgery at Albert Einstein College of Medicine (New York, NY, USA). "As many as two-thirds of patients who need treatment for a ruptured aortic aneurysm could be candidates for this technique.”

Doctors allow a patient's blood pressure to fall to low levels before and during endograft repair by restricting fluid resuscitation. "This limits the bleeding, and we have found this approach, which we call hypotensive hemostasis, to be very effective,” added Dr. Veith.




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