Stent-grafts offer alternative to surgery for AAA ruptures

If patients are hemodynamically stable, ruptured abdominal aortic aneurysms can be treated with stent grafting rather than surgical repair, Italian and Swiss researchers reported Monday. With about 100 cases reported in two unrelated studies, the procedure appears safe with a low complication rate.

Researchers at Ospedale Di CIrcolo in Varese, Italy, performed 77 stent-graft procedures and 131 surgical interventions between 2001 and 2003. Patients were evaluated for blood loss and stability in the emergency room and examined with CT if stable. High-risk patients were referred for immediate surgery. Stent-graft procedures took an average 128 minutes.

The Italian group reported 100% technical success, Dr. Gianpaolo Carrafiello reported at the European Congress of Radiology. There were two mortalities related to arrhythmia, three cases of infection or other morbidity, and two type 2 endoleaks during follow-up.

In a 37-patient population, researchers at Zurich University Hospital reported a 10.8% mortality rate at 30 days, though none of the deaths were associated with the stent-graft procedure. With an average follow-up time of more than two years, the team found that patients had a 35% chance of needing a second intervention at two years, and a 44% chance at three years. The chance of staying free of endoleaks three years postprocedure was 51%, said lead researcher Dr. Lukas Hechelhammer.