Brandon T. Garland, Elina Quiroga, Benjamin W. Starnes, Thomas Hatsukami, Nam T. Tran
Division of Vascular Surgery, University of Washington, Seattle, WA.
OBJECTIVES: The management of ruptured abdominal aortic aneurysm (rAAA) has undergone significant changes within the last decade with endovascular repair now the preferred operative approach. We hypothesized that some endoleaks after endovascular repair of rAAA can be managed expectantly while others require urgent intervention to due to ongoing hemorrhage.
METHODS: In an IRB approved study, all patients admitted with the diagnosis of rAAA from July 2007 to December 2011 were entered into a prospectively maintained database. Patients with ruptured endovascular aneurysm repair (rEVAR) and computer tomographic angiography (CTA) performed within the first 30 days of repair were included in the analysis. Images were analyzed by attending radiologists for presence and type of endoleak as well as aneurysm size. Relevant patient data such as hemodynamic status, hematocrit level, transfusion requirement, hospital length of stay, and outcome were analyzed.
RESULTS: Fifty-four patients were identified who underwent rEVAR with 34 of those patients having CTA performed within 30 days of the procedure. The mean age was 74.5 years with 79% males. Three type I endoleaks, one type III endoleak, and 5 type II endoleaks were identified. The overall endoleak rate was 23.5 % (8/34). Two out of three type I endoleaks required urgent re-intervention due to hemodynamic instability. The patient with type III endoleak was stable but had an increased in size of retroperitoneal hematoma and sac diameter on follow up imaging and thus underwent re-intervention. No type II endoleak required further intervention. At two years, all endoleaks except two type II have resolved.
CONCLUSIONS: The rate of endoleak after rEVAR is higher than that reported for elective EVAR. Type II endoleak resolved spontaneously over time and should be managed conservatively. Conversely, type I and III endoleaks can lead to continual rapid hemorrhage and should be intervened on. CTA should be performed on all patients that underwent rEVAR prior to discharge.
AUTHOR DISCLOSURES: B. T. Garland, Nothing to disclose; T. Hatsukami, Nothing to disclose; E. Quiroga, Nothing to disclose; B. W. Starnes, Nothing to disclose; N. T. Tran, Nothing to disclose.
Posted April 2012