Endovascular treatment for ruptured abdominal aortic aneurysm

October 2017

Ageing

Country of origin: USA

The abdominal aorta is the main artery supplying blood to the lower part of the body. An abnormal ballooning and weakening of the wall of the aorta (aortic aneurysm) particularly affects men as they grow older. An aneurysm may progressively enlarge without obvious symptoms yet it is potentially lethal as the aneurysm can burst (rupture) causing massive internal bleeding. Death is inevitable unless the bleeding can be stopped and blood flow to the lower body restored promptly.

Until recently this required laparotomy to clamp the abdominal aorta and replace the segment of the aorta with a synthetic artery tube-graft. Many patients do not survive this major operation due to the effects of massive bleeding or failure of vital organs, such as the heart, lungs, and kidneys despite improvements in surgical technique and care of the critically ill patient.

A recent minimally invasive technique, termed endovascular repair, allows the surgeon to pass a stent graft through the blood vessels from the groin to the site of rupture where it is positioned, attached to healthy artery above and below the aneurysm to stop bleeding and form a new channel for blood flow. This technique is successful in suitable patients for the planned treatment of non-ruptured aneurysms and can reduce early post-operative complications and deaths.

The present review looked at the available evidence for its effectiveness compared with open surgery for ruptured aneurysms. The review authors searched the medical literature but found no completed randomised controlled trial.
Evidence from case series, 10 prospective and 21 retrospective reports, indicates that emergency endovascular repair is feasible and may reduce blood loss, duration of stay in intensive care and deaths in selected patients. These reports were from vascular surgery centres with considerable experience of the technique.

The Cochrane review is available online.

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