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Home > Vascular Annual Meeting > VS3. A Protocol for Endovascular Treatment of Ruptured...

VS3. A Protocol for Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

Obinna Nwobi, Manish Mehta, R. Clement Darling III, Sean P. Roddy, Devin Zarkowsky, Yaron Sternbach, John B. Taggert, Paul B. Kreienberg, Philip SK Paty, Kathleen J. Ozsvath, Benjamin B. Chang, Dhiraj M. Shah
The Vascular Group, PLLC, Albany, NY

OBJECTIVES: Endovascular therapy is fast replacing open repair as the choice modality in r‐AAA repair. We offer a demonstration of our center’s process honed over eight years as a perspective to others navigating the complex interdepartmental and logistical issues associated with instituting this protocol.

METHODS: We selected an archetypal case from the 92 r‐AAA EVAR’s completed between 2001 and 2008 and filmed a real‐time reenactment. Pre‐operative steps shown include ER staff recognizing an r‐AAA then quickly alerting the on‐call vascular surgery team and OR staff. Vascular team members then assess the patient’s hemodynamic stability and deciding on a CT, planning OR layout for both EVAR and open procedures as well as orchestrating efforts from anesthesiologists, OR staff and radiology technicians. In the operating room, the surgeon performs a femoral cut‐down and rapidly obtains proximal balloon aortic control. Highlights from graft implantation follow, including aortoiliac and infrarenal aortic neck morphology visualization as well as contralateral gate cannulation.

RESULTS: Endovascular therapy for r‐AAA at our center shows a mortality rate approximately one-third that seen in open repair.

CONCLUSIONS: We hope our experience enables other centers to successfully adopt this strategy.

AUTHOR DISCLOSURES: O. Nwobi, None; M. Mehta, W.L. Gore, Medtronic, Cordis, Aptus, Cardio MEMS, Endologix; R.C. Darling, W.L. Gore, Cordis, Medtronic; S.P. Roddy, None; D. Zarkowsky, None; Y. Sternbach, W.L. Gore, Medtronic, Cordis, Cardio MEMS; J.B. Taggert, W.L. Gore, Medtronic, Cordis, Cardio MEMS; P.B. Kreienberg, W.L. Gore, Medtronic, Cordis, Cardio MEMS; P.S.K. Paty, W.L. Gore, Medtronic, Cordis, Cardio MEMS; K.J. Ozsvath, W.L. Gore, Medtronic, Cordis, Cardio MEMS; B.B. Chang, W.L. Gore, Medtronic, Cordis, Cardio MEMS; D.M. Shah, W.L. Gore, Medtronic, Cordis, Cardio MEMS.