Resumen de Endovascular Treatment of Aortic Aneurysm Rupture

Mariano Ferreira, Sergio Escordamaglia, German Castillo, Julio Rosemberg, Carlos A. Ingino, Ricardo La Mura

• español

  Introducción: El motivo de la presentación es mostrar nuestro protocolo quirurgico de tratamiento del paciente con aneurisma de aorta abdominal roto (AAA-r) Material y Métodos: Diecisiete pacientes fueron tratados bajo protocolo de “abordaje endovascular primero”. Se clasificó la población en función de la presión arterial sistólica (PAS) de ingreso: hemodinámicamente estable (PAS ≥ 80 mm Hg), inestables (PAS <80 mm Hg durante >10 minutos). Los resultados incluyeron mortalidad a 30 días, en el seguimiento y complicaciones post-procedimiento. El análisis estadístico se realizó mediante test de Fisher. Resultados: Los mortalidad a 30 días fue 23,5%. El éxito técnico se logró en 94,1%. Si bien, ambos grupos tuvieron comorbilidades similares, los pacientes estables, operados bajo anestesia local, presentaron una tasa de mortalidad del 7,7% (p<0.02). Conclusión: El tratamiento endovascular del AAA-r, siguiendo un estricto manejo clínico quirúrgico, es factible y seguro, especialmente en pacientes estables bajo anestesia local. 

• English

  Introduction: Endovascular repair of aortic aneurysm emerges as a less invasive option for patients with high operative risk, constituting a feasible and safe treatment due to technical advances. For this reason, our institution considers endovascular treatment as the “first line therapy” in patients with very high operative risk, as those with ruptured abdominal aortic aneurysm.Objective: The goal of this study is to report the experience with our surgical treatment protocol of patients with ruptured abdominal aortic aneurysm.Methods: Seventeen patients were treated based on the protocol “endovascular approach first”. The population was classified according to systolic blood pressure (SBP) at admission in: hemodynamically stable (SBP ≥ 80 mm Hg) or hemodynamically unstable (SBP < 80 mm Hg during > 10 minutes). The outcomes included mortality at 30 days and during follow-up and complications after the procedure. The statistical analysis was performed using Fisher’s test.Results: Mortality at 30 days was 23.5%. Technical success was achieved in 94.1% of patients. Despite both groups had similar comorbidities, mortality in stable patients, operated on under local anesthesia, was 7.7% (p < 0.02).Conclusion: Endovascular treatment of ruptured abdominal aortic aneurysm, following a strict clinical and surgical treatment, is feasible and safe, particularly in stable patients under local anesthesia.