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