20 - Freie Mitteilung
15. Mai 2019, 13:30 - 15:00, Sopra Grande, 4. OG
Endograft sizing in patients with RAAA
M. Gajic1, 2, D. Jaeger1, H. Szèkessy1, M. Lachat1, Z. Rancic1, Presenter: Z. Rancic1 (1Zürich, 2Luzern)
Ruptured abdominal aortic aneurysm (RAAA) untreated is fatal. Whether open surgery or emergent endovascular (eEVAR) is the preferable treatment is an ongoing debate. Due to appropriate perioperative management of the patient and clearly defined standardized operating procedure successful outcomes are shown. Five key elements are crucial for treatment of an RAAA by eEVAR: Hemodynamics, Imaging, Procedure, Abdominal Compartment Syndrome and Teamwork. Hemodynamics is comprised of hypotensive hemostasis by permissive hypovolemia and controlled hypotension. Sizing in eEVAR procedure is performed in hypotensive patients. The objective of our study is to investigate changes in aortic diameter in hypotensive patients with RAAA.
Included are all patients with RAAA treated by eEVAR at our institution during the period 2003-2015. Inclusion criteria are systolic blood pressure below or equal 100 mmHg at CTA used for sizing. Patients had a thoracoabdominal CTA at admission, after intervention, at 3 and 12 months postoperative. Exclusion criteria were RAAA treated with complex endovascular aneurysmrepair and those with incomplete CTA data. Measurements in axial plane at different levels according to predefined protocol was done.
Maximum change of the diameter in percentage at 12 months compared to admission was: at the level of external iliac artery (+13%), aortic arch (+11%) and common iliac artery (+8%). The difference of the ascending aorta compared to admission was +6%, descending aorta +5% and 1cm above lower renal artery +6%.
The diameter of the aorta and the iliac arteries in the CTA in patients with RAAA is influenced by hemodynamic changes during permissive hypovolemia and controlled hypotension. The most significant decrease of the mean diameter, in our cohort, is observed in the external iliac artery (13%) and the common iliac artery (8%). In patients with RAAA and systolic blood pressure below or equal to 100 mmHg, the decrease in diameter of the aorta might result in inadequate sizing of the stent grafts during eEVAR. Further analysis of the clinical implications of over- or undersizing will be examined on secondary interventions and the follow-up period.