Spiral-CT angiography to assess feasibility of endovascular aneurysm repair in patients with ruptured aortoiliac aneurysm

Background: To evaluate spiral computed tomography (SCT) angiography for as sessment of feasibility of endovascular aneurysm repair (EVAR) in patients with ruptured aortoiliac aneurysm (AAA). Patients and methods: 24 patients (mean age 74 years; range, 69 to 82 years ) with suspicion of ruptured AAA and stable hemodynamics were preoperativel y examined by using a SCT scanner in the emergency room. SCT angiography wa s performed from the suprarenal aorta to the femoral bifurcation after a fi xed injection delay time of 30 seconds. After that a venous phase SCT scan, beginning at the last image position and ending at the upper thoracic aper ture, was performed. Results: The mean acquisition time of the SCT scan was 80 seconds (range 70 to 100 seconds), the mean overall procedure time, including image reconstr uction, 5 minutes (range, 4 to 6 minutes). 2D images were directly evaluate d during CT data acquisition, and 3D image reconstructions within 10 minute s (range, 8 to 11 minutes) after the SCT scan. AAA rupture was assessed in 14/24 patients (58%): in 10/14 patients (71%) rupture was contained to the retroperitoneum, and in 4/14 patients (29%) intraperitoneal rupture was obs erved. Successful EVAR was performed in 6/14 patients (43%) with ruptured A AA, and in 8/10 patients (80%) without ruptured AAA. Open surgery was exclu sively performed in 6/24 patients (25%) with inappropriate anatomy for EVAR and in 4/24patients (17%) with intraperitoneal rupture. Conclusions: Spiral computed tomography angiography is a reliable technique to assess feasibility of endovascular aneurysm repair in patients with rup tured aortic aneurysm. However, it can only be recommended for patients wit h stable hemodynamics, despite of the short acquisition time.