Endovascular Treatment of Aortic Aneurysm Rupture

Introduction: Endovascular repair of aortic aneurysm emerges as a less invasive option for patients with high operative risk, constituting a feasible and safe treatment due to technical advances. For this reason, our institution considers endovascular treatment as the “first line therapy” in patients with very high operative risk, as those with ruptured abdominal aortic aneurysm.Objective: The goal of this study is to report the experience with our surgical treatment protocol of patients with ruptured abdominal aortic aneurysm.Methods: Seventeen patients were treated based on the protocol “endovascular approach first”. The population was classified according to systolic blood pressure (SBP) at admission in: hemodynamically stable (SBP ≥ 80 mm Hg) or hemodynamically unstable (SBP 10 minutes). The outcomes included mortality at 30 days and during follow-up and complications after the procedure. The statistical analysis was performed using Fisher’s test.Results: Mortality at 30 days was 23.5%. Technical success was achieved in 94.1% of patients. Despite both groups had similar comorbidities, mortality in stable patients, operated on under local anesthesia, was 7.7% (p 10 minutos). Los resultados incluyeron mortalidad a 30 días, en el seguimiento y complicaciones post-procedimiento. El análisis estadístico se realizó mediante test de Fisher. Resultados: Los mortalidad a 30 días fue 23,5%. El éxito técnico se logró en 94,1%. Si bien, ambos grupos tuvieron comorbilidades similares, los pacientes estables, operados bajo anestesia local, presentaron una tasa de mortalidad del 7,7% (p<0.02). Conclusión: El tratamiento endovascular del AAA-r, siguiendo un estricto manejo clínico quirúrgico, es factible y seguro, especialmente en pacientes estables bajo anestesia local.

Experience with a Fenestrated Stent Graft. A Case Report

In this presentation we describe the first case of a juxtarenal aortic aneurysm treated in our country by placing an endograft with multiple fenestrations. This is a high surgical risk patient due to clinical comorbidities, to whom under regional anesthesia was placed an endograft with fenestrations to preserve the blood flow to the celiac trunk, superior mesenteric artery and both renal arteries. The procedure was successful with complete exclusion of the aneurysm. The first postoperative control showed exclusion of aneurysm with adequate patency of the visceral branches.     In patients with juxtarenal abdominal aortic aneurysm, the normal segment of infrarenal aorta necessary to obtain the proximal anchoring endograft is insufficient or lacking, for what with traditional endografts, there is no possibility of sealing or excluding the aneurysm. For this reason, in recent years, endografts with fenestrations (orifices) have been used for the preservation of visceral and renal branches as a valid and less invasive therapeutic alternative.En los pacientes con un aneurisma de la aorta abdominal yuxtarrenal, el segmento normal de aorta infrarrenal necesario para lograr el anclaje proximal de una endoprótesis es insuficiente o inexistente, por lo que con las endoprótesis tradicionales no existe la posibilidad de sellar o excluir el aneurisma. Por este motivo, en los últimos años se han utilizado endoprótesis con fenestraciones (orificios) para la preservación de los ramos viscerales y renales como alternativa válida y menos invasiva