Giustino Marcucci. Endovascular treatment in emergency of para-anastomotic aneurysms (true and false)

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1 Endovascular treatment in emergency of para-anastomotic aneurysms (true and false) Giustino Marcucci Chief of Vascular and Endovascular Surgery Unit (F. Accrocca, R. Antonelli, G.A. Giordano, A. Siani) Ospedale San Paolo Azienda USL RM-F, Civitavecchia, Roma (Italy)

2 Faculty disclosure Giustino Marcucci I have no financial relationships to disclose.

3 Surgical Treatment -) Redo surgery leads to extreme technical difficulty -) Suprarenal aortic clamp site has been associated with an increased morbidity and mortality Mortality rate associated with attempted surgical repair of ruptured PAA varies from 24 to 88% Endovascular Treatment The endovascular approach is a safe alternative procedure in the management of elective and emergency situations particularly in patients unfit or at high-risk for open surgery but in presence of favorable anatomy The endovascular approach has dramatically changed the prognosis of the PAAs treatment

4 Endovascular treatment in emergency in of of paraanastomotic aneurysms (true (true and and false) para-anastomotic false) Anastomotic pseudoaneurysms and true para-anastomotic aneurysms after initial open abdominal aortic prosthetic reconstruction often need reintervention because they are at risk for rupture. However, open surgical reinterventions are technically challenging procedures with high mortality and morbidity rates. In the present multicenter study, we describe the long-term clinical course in an expanded number of patients who underwent endovascular repair of paraanastomotic aneurysms after previous open reconstruction Ten Bosch et al. An endovascular stent graft was used to treat 58 patients (53 men; mean age, 71 ± 9 years), with 80 aortic or iliac pseudoaneurysms or true para-anastomotic aneurysm, or both. Bifurcated stent grafts were used in 32 patients, endovascular tube grafts in eight, aortouniiliac stent grafts in seven, and iliac extension grafts in 11. Stent graft deployment was successful in 55 patients, for a technical success rate of 95%. Median hospital admission was 3 days (range, days). The 30-day and in-hospital mortality rates were 3.4% (n = 2) and 6.9% (n = 4), respectively.

5 2013

6 75 years Prior aortobi-iliac bypass 16x8 performed 10 y before for AAA Severe abdominal pain with impending risk of rupture CTA: PAA 6.5 cm. A-P diameter

7 Bilateral axillary and left inguinal access Gore TAG 34x10 tube graft Bilateral Gore VIABAHN 6X5

8 82 years Prior aorto-bi-iliac by-pass performed 12 years before for AAA At the casualty with sudden abdominal pain, hemorrhagic shock, Hb value 7.9 g/l Urgent CTA scan showed a ruptured false distal iliac PAA with free blood in the left iliac fossa Stabilized the patient, angiography was immediately performed in theatre

9 Very fast procedure No major blood loss Rapid hemodynamic stabilization after endograft deployment xclusion by Viabahn 8x10 endograft

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11 Endovascular treatment in emergency of para-anastomotic

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13 Endovascular treatment in in emergency of of paraanastomotic aneurysms (true and and false) para-anastomotic he results of treatment of PAAs have improved in the last years. Current results of endovascular repair of para-anastomotic aortic and iliac aneurysms Author Year No Mortality (%) Pearce BJ % Sachdev U % Cernà M % Mitchell JH % Piffaretti G % Ziegler P % Verhoeven EL % Ten Bosch JA % Tsang JS %

14 Endovascular treatment in in emergency of of paraanastomotic aneurysms (true (true and and false) para-anastomotic Discussion topics: Increasing incidence longevity of the patients PAAs a challenge for elective open repair with mortality between 4.5 and 17% and a mortality rate in emergency of ruptured PAAs between 24 and 88% (literature) The endovascular treatment is effective with excellent outcome (lower mortality and morbidity) Individual choise of therapeutic is necessary

15 Tank you Pantheon, Roma The house of the Gods