Endovascular versus conventional open repair of acute abdominal aortic aneurysm: feasibility and preliminary results.

Purpose: To evaluate the feasibility of endovascular treatment of acute abdominal aortic aneurysm (AAA) with commercially prepared bifurcated systems.
Methods: From January through July 2001, 22 patients (17 men; mean age 73.6 years, range 59-89) were referred with an acute (symptomatic/ruptured) AAA. Six patients were treated with emergent open surgery because of hemodynamic instability, but the other 16 patients underwent computed tomographic angiography with multidirectional reconstruction. Six (27%) aneurysms were suitable for endovascular repair (EVR) and were successfully treated. Procedural variables, morbidity, and mortality were compared between the EVR group and 6 patients of equivalent hemodynamic status from among the conventionally treated patients.
Results: There was no mortality in either group. The median aneurysm diameter in the EVR group was 63 mm (range 48-84) versus 80 mm (45-82) in the matched surgically treated AAAs (p=0.628). Procedural duration was 193 minutes (150-265) for the EVR group compared to 203 minutes (130-270) for the matched group (p=0.630). Median blood loss was significantly less (p=0.010) in the EVR group (125 versus 3400 mL). Median length of stay (LOS) in intensive care was 8 hours (0-21) versus 62 hours (48-112) for the surgical group (p=0.004). Hospital LOS was significantly reduced (p=0.024) for the EVR patients (7.5 [2-16] versus 15.5 [10-34] days).
Conclusions: Endovascular treatment of acute aneurysm is feasible, and preliminary results are promising.