An endoluminal method of hemorrhage control and repair of ruptured abdominal aortic aneurysms

Purpose: To report our initial experience with endovascular grafting to tre at ruptured abdominal aortic aneurysms (AAAs). Methods: Three consecutive patients with severe comorbid illnesses and symp toms of aneurysm rupture and hemodynamic instability were treated with aort omonoiliac grafts. The Z-stent-based devices were implanted with the assist ance of an occlusion balloon placed in the distal descending thoracic aorta . Results: AII patients survived the procedure with successfully excluded AAA s. Two patients had relatively short hospital stays (4 and 14 days), while the third required prolonged treatment for pre-existing conditions. Ail pat ients required blood transfusions; 2 developed significant coagulopathies. Definitive management was delayed significantly by imaging protocols and gr aft construction. Conclusions: Endovascular repair of ruptured aortic aneurysms is feasible. Proximal aortic control is readily attainable with the use of an aortic occ lusion balloon placed through the left axillary artery. The absence of a la parotomy, extensive retroperitoneal dissection, and aortic cross-clamping l ikely contributes to patient survival; however, the delay in operative ther apy to obtain adequate imaging and construct an endograft could be a hindra nce to the ultimate success of this approach. The concepts of alternative a ortic imaging techniques and endograft design, construction, and storage mu st be addressed.