Endovascular graft repair of ruptured aortoiliac aneurysms

Background: The feasibility of endovascular graft (EVG) repair of ruptured aortoiliac aneurysms (AIAs) has yet to be demonstrated. There are inherent limitations in EVG repair, including the need for preoperative measurements of the aneurysmal and adjacent arterial anatomy to determine the appropria te size and type of graft and the inherent delay to obtain proximal occlusi on. We developed an EVG system with broad versatility that largely eliminat es these problems. Study Design: Between 1993 and 1998, within an experience of 134 endovascul ar AIA repairs, 12 ruptured AIAs were treated using EVGs that facilitated i ntraoperative customization and eliminated the need for preoperative measur ements. The EVGs consisted of either a Palmaz stent and a PTFE graft deploy ed by a compliant balloon (n = 9) or a self-expanding covered stent graft ( n = 3). Both grafts were cut to the appropriate length intraoperatively. Th e mean age of the patients was 72 years (range 40 to 86 years). The mean si ze of the aneurysms was 7.6 cm (range 3 to 16 cm). Preoperative symptoms we re present in all patients and included abdominal or back pain (n = 9), syn cope (n = 4), and external bleeding (n = 2). Ah patients were high surgical risks because of comorbid disease (n = 10) or previous abdominal operation s (n = 6), and nine experienced hypotension. Results: Ah EVGs were inserted successfully and excluded the aneurysms from the circulation. The mean operating time was 263 minutes, the mean blood l oss was 715 mL, and the mean length of hospital stay was 6.5 days. There we re two deaths (16%), one from the preexisting acute myocardial infarction a nd one from multiple organ failure. There were three minor complications (2 5%). Two patients required evacuation of an intraabdominal hematoma from th e initial rupture. Ah but one of the grafts was functioning at a mean follo wup of 18 months. Conclusions: This study demonstrates the feasibility of EVG repair for rupt ured AIAs using a graft that can be customized intraoperatively for each pa tient. Such repairs currently are valuable in patients with ruptured AIAs a nd serious comorbidities and may be applicable in other circumstances as we ll. (J Am Cell Surg 1999;189: 102-113. (C) 1999 by the American College of Surgeons).