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Endovascular Treatment of Acute Aortic
Emergencies: Early Results
Badr Aljabri, MD, FRCSCKing 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 2007- 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 2007- January 2008
17 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 26-34 mm
Number of patients
Number of stents
Technical success rate %
Left SCA Coverage
30-day mortality rate (%)
Complications
Blunt Thoracic Rupture
5 5 100 3 0 0
Ruptured true thoracic aortic aneurysms
4 7 100 0 2 (50) 1MI
Ruptured proximal anastomotic aortic psudoaneurysm
1 1 100 NA 0 0
Total 10 13 100 3 2 (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 MortalityNeurological injury Subgroup analysis
Retrospective review 74 patients35 open VS 39 TEVAR
30 day mortality 20% surgical group7.7% 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
Thank You