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Protocol Suggested for Abdominal Aortic Aneurysm Repair
Collaboration And Communication Of Medical Staff Can Improve Mortality Rates
CHICAGO (July 01, 2006) —
Establishment of protocol and including endovascular trained staff and availability of adequate equipment including ‘off-the-shelf’ stentgrafts, will help facilitate endovascular ruptured abdominal aortic aneurysm repair
(r-AAA).
Manish Mehta, MD, director of endovascular services for The Vascular Group, Albany Medical Center, NY, led a study where vascular surgeons, anesthesiologists, operating and emergency room staff, and radiology technicians collaborated on this procedure. Early results indicate that endovascular repair of r-AAA in both hemodynamically stable and unstable patients were associated with a limited mortality of 18 percent, when standardized protocol is established. The findings were published in the July issue of the Journal of the Society of Vascular Surgeons.
A simulation of patients presenting to the ER with r-AAA was rehearsed with the emergency room staff, anesthesiologists, OR staff, radiology technicians, and the vascular surgeons so all had knowledge of the sequence of steps involved. The ER physician alerted the vascular surgeon, who subsequently alerted the OR staff. An abdominal & pelvic CT scan was obtained in hemodynamically stable patients only, and all unstable patients were transported directly to the operating room which was set-up for interventional capabilities “The resulting treatment algorithm can minimize delays and increase our chances of offering endovascular treatment options for hemodynamically unstable patients with r-AAA,” said Dr. Mehta.
He added that endovascular repair of r-AAA results in a lower incidence of postoperative complications of myocardial infarction (5%), renal failure (5%), and ischemic colitis (5%) when compared to open surgery. However, postoperative complication of abdominal compartment syndrome (ACS) can occur in 17% of patients and is responsible for significant morbidity and mortality. The overall mortality was only nine percent (3 of 33 patients) without ACS, and 57 percent when patients developed ACS.
“During the past decade endovascular therapy has revolutionized our ability to treat vascular disease, and its greatest impact on saving lives has been on patients with ruptured abdominal and thoracic aortic aneurysms,” said Dr. Mehta. “However, there is a steep learning curve and increased recognition of emerging complications with an endovascular approach, and multidisciplinary protocol must be developed to initiate a successful program for endovascular treatment of r-AAA.”
About Journal of Vascular Surgery
Journal of Vascular Surgery provides vascular, cardiothoracic and general surgeons with the most recent information in vascular surgery. Original, peer-reviewed articles cover clinical and experimental studies, noninvasive diagnostic techniques, processes and vascular substitutes, microvascular surgical techniques, angiography and endovascular management. Special issues publish papers presented at the annual meeting of the Journal's sponsoring society, the Society for Vascular Surgery. Visit the Journal Web site.
About the Society for Vascular Surgery
The Society for Vascular Surgery (SVS) is a not-for-profit medical society that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 2,400 vascular surgeons dedicated to the prevention and cure of vascular disease.
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© 2008 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.