Joern Oliver Balzer MD, Presenter: Nothing to Disclose

Mirko Doss MD, Abstract Co-Author: Nothing to Disclose

Axel Thalhammer MD, Abstract Co-Author: Nothing to Disclose

Martin G. Mack MD, Abstract Co-Author: Nothing to Disclose

Anton Moritz MD,PHD, Abstract Co-Author: Nothing to Disclose

Thomas Josef Vogl MD, Abstract Co-Author: Nothing to Disclose

To demonstrate the effectiveness of endovascular stent grafts in the treatment of acutely ruptured thoracic aortic aneurysms and type B dissections as an alternative to the conventional surgical approach in an emergency setting.

From January 2001 to September 2004, we treated 47 patients with either ruptured aortic aneurysms (n= 28) or acutely perforated type B dissections (n=19) with endovascular stentgraft implantation. Aortic rupture was confirmed preoperatively by spiral computed tomography. In all cases, hemothorax as well as periaortal hematoma was present. The mean interval from onset of symptoms to treatment was 18.5 hours. We used 58 Talent (Medtronic Inc.) and six Excluder (W.L. Gore Inc.) stent grafts. All interventions were performed in an angiographic suite in general anesthesia and cardiac arrest in 34 cases.

Stentgraft implantation was successful in 45 patients. Access failure due to small caliber of iliac arteries was encountered in one case, and one patient died before endograft implantation could be achieved. Complications encountered were paraplegia (n= 1), primary endoleak (n= 3), temporary renal failure (n=1), and prolonged mechanical ventilation (n=2). All patients with endoleaks could be successfully treated by a second Stentgraft implantation. At the 12 months follow-up 1 patient had died due to multiorgan failure, and two patients needed conversion two conventional surgical repair. All other patients were alive and free of symptoms.

Our experiences with emergency endovascular stent grafting show that the procedure is technically feasible, with less morbidity and mortality than conventional open surgery, in high-risk patients.

Balzer, J, Doss, M, Thalhammer, A, Mack, M, Moritz, A, Vogl, T, Emergent Endovascular Stent Graft Implantation for Perforated Acute Type B Dissections and Ruptured Thoracic Aortic Aneurysms.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4416524.html