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Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

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Jakuczun W., Szostek M., Pogorzelski R., Szostek M., Skórski M.
Polish Journal of Surgery
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2008
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vol. 80
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issue 8
381-386
EN
Aortic aneurysms, especially when ruputured, constitute a direct life threat. Mortality in emergency surgical procedures has been estimated at 50 to 90%. In the recent years great advances have been achieved in the form of endovascular techniques, which offer effective treatment and are associated with a lower risk of complications and death.The aim of the study was to evaluate endovascular treatment in patients with hypovolaemic shock due to aortic rupture in the infrarenal segment.Material and methods. 19 patients with ruptured aortic aneurysms were treated by stentgraft implantation in our department from 2001 to 2006. Bifurcated stentgrafts were used in 6, while aortouniiliac stentgrafts were used in the remaining 13 with consecutive femoro-femoral by-pass grafting.Results. Good results were obtained in 14 (73.7%) patients operated on while in hypovolaemic shock caused by aortic aneurysm rupture.5 patients died in the perioperative period (26.3%). The deaths were caused by shock and multiple organ failure.Conclusions. 1. Advances in vascular surgery offer an effective treatment for patients in hypovolaemic shock due to abdominal aortic aneurysm rupture. 2. New treatment modalities do not lift the surgeon's responsibility to manage shock, which remains the main cause of death in patients with ruptured aortic aneurysms. 3. If the technical conditions for stentgraft implantation are met, endovascular procedures should be the method of choice in cases of ruptured abdominal aortic aneurysm.
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Endovascular Treatment of Innominate Artery Aneurysms

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Jakuczun W., Szostek M., Pogorzelski R.
Polish Journal of Surgery
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2007
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vol. 79
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issue 7
403-407
EN
In 2004, two patients were operated on due to innominate artery aneurysms in the Department of General and Thoracic Surgery.The first patient was a 53 year old man admitted to the hospital with suspicion of lung neoplasm, haemoptysis and dyspnoea. AngioCT revealed a ruptured aneurysm of the innominate artery. An urgent endovascular procedure was performed with stentgraft implantation. There were no complications during the procedure and recovery. He was discharged in good condition on the twelfth postoperative day. At the three month follow-up visit, he had no complaints.The second patient was a 73 year old man who had been followed for two years because of a slowly growing aneurysm of the innominate artery. Elective operation was performed with stentgraft implantation. He developed arm ischemia during first postoperative day due to subclavian steal syndrome. After thoracic pharmacological sympathectomy, the problem was solved. At the six month follow-up visit, he was asymptomatic.
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The evaluation of the postoperative course in patients operated due to abdominal aortic aneurysm as urgent or elective procedure

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Rucińska Z., Juzwiszyn J., Bolanowska Z., Malinowski M., Pormańczuk K., Chabowski M., Janczak D.
Polish Journal of Surgery
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2018
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vol. 90(6)
20-26
EN
Introduction: The patients with the aortic abdominal aneurysym of 55 mm in diameter are qualified to surgery. There are open repair (OR) by means of the vascular prosthesis implantation or the less invassive endovascular method by means of the stentgraft implantation through femoral arteries incision (EndovascularAorticRepair – EVAR). Aim: The aim of the study was the evaluation of the postoperative course in patients operated due to aortic abdominal aneurysm and the evaluation of the impact of the surgical method on the short-time results. Material and methods: 124 patients operated due to abdominal aortic aneurysm in Dept of Surgery of 4th Military Hospital in Wroclaw in 2014 were enrolled into the study: 53 patients with OR, 53 patients with EVAR, and 19 patients with ruptured aneurysm. Results: Mortality was 0% in EVAR and 6% in OR and 39% in ruptured aneurysm. Time of hospital stay was 5.8 days in EVAR vs 10 days in OR. The stay in ICU was 0% in EVAR vs 13% in OR. Blood transfusion was 9.4% in EVAR vs 66% in OR. Time of postoperative analgesia was 27 h in EVAR vs 76.8 h in OR. Cardio-respiratory decompensation was 1.9% in EVAR vs 7.6% in OR. Renal insufficiency was 2% in EVAR vs 9% in OR. The lower rate of organ complications was in EVAR. The ruptured aneurysm presented the most complicated postoperative course: hospital stay of 11.4 days, ICU stay of 78%, blood transfusion of 100%, painkillers of 136 hours, cardio-respiratory decompensation of 81% and renal insufficiency of 69%. Conclusions: The method of treatment, the conditions of the admision and the type of surgery influenced the postoperative course. The elective EVAR patients presented both the 0% of mortality and the lightest postoperative course. The ruptured abdominal aortic aneurysms operated as an emergency had the most complicated postoperative course.
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