Endovascular approaches to ruptured infrarenal aorto-iliac aneurysms

BACKGROUND: Ruptured abdominal aortoiliac aneurysms (RAAAs) carry a high mortality when treated by open surgical repair. Since 1994, we have employed endovascular approaches to treat this entity. METHODS: Patients with presumed RAAAs were treated with restricted fluid resuscitation (hypotensive hemostasis), rapid transport to the operating room, placement of a transbrachial or transfemoral guidewire under local anesthesia, and urgent arteriography. In patients with suitable anatomy, endovascular graft repair was performed. If the anatomy was unsuitable, standard open repair was performed. If the patient had circulatory collapse, proximal balloon control was employed. RESULTS: Of 31 patients managed in this fashion, 25 underwent endovascular graft repair. Six required open repair. Total operative mortality was 9.7% (3 patients). Only 10 patients required proximal balloon aortic control. CONCLUSIONS: Endovascular techniques (proximal balloon control and endografts) may improve treatment outcomes for RAAAs. Restricted resuscitation (hypotensive hemostasis) can be effective in the RAAA setting.