Ruptured abdominal aortic aneurysm: endovascular treatment P. Castelli, 1 R. Caronno, 1 G. Piffaretti, 1 M. Tozzi, 1 D. Lagana `, 2 G. Carrafiello, 2 S. Cuffari, 3 A. Bacuzzi 3 1 Department of Surgery, University of Insubria, Ospedale di Circolo, 21100, Varese, Viale Borri 57, Italy 2 Department of Radiology, University of Insubria, Ospedale di Circolo, 21100, Varese, Viale Borri 57, Italy 3 Anesthesia and Palliative Care, Ospedale di Circolo, 21100, Varese, Viale Borri 57, Italy Abstract Background: This report describesour preliminary experience in endovascular management of 25ruptured abdominal aortic aneurysms (rAAAs). Methods:In the past 3 years we treated 46 patients who had rAAA, and 25(54.3%) were treated with an endo- vascular approach. PatientsÕ mean age was 76 ± 9 years. The diagnosis was confirmed by computed tomographic angiographyin 23 patients(92%). Mean aneurysm diameterwas 73 ± 17 mm. We used an infrarenal bifurcated device in 17 patients (68%),a suprarenal bifurcated in four patients (16%), and an aortomonoiliac graft in four patients (16%). Overall, nine patients (36%) required intensive care. Every patient underwent radio- logic follow-up according to the Eurostar register, with concomitantevaluation ofthe D-dimer level(cut-off <200 lg/L) as a biological marker for endoleaks. Results:The primary technical success rate was 100%. Overallin-hospitalmortality rate was 20%. Mean hos- pitalization was 7 days (range, 3–30),and mean follow- up was 7 months. One occlusion (4%) of the iliac limb and two type II endoleaks(8%)occurred.The mean D-dimer level in type I endoleak was 1045 lg/L (range, 459–2021). Conclusions: In our experience, endovascular manage- ment of rAAA is feasible and safe and produces better resultsthan conventional surgery,provided themor- phology is suitable and the procedure is carried out by an experienced endovascular team. Key words:Ruptured abdominal aortic aneurysm—En- dovascularrepair—Computed tomographic angiogra- phy—D-dimer In the past two decades, major improvements have mad elective repair of abdominal aortic aneurysms (AAAs) a safe procedure, with a mortality rate as low as 5% [1, 2] Moreover, the introduction of endovascular aortic repair (EVAR) has enabled surgery in patients who are at in- creased risk with conventional open surgery (OS) [3]. In the same period, the incidence of ruptured AAAs (rAAAs) has not changed [2, 4]. Despite rapid prehospita transport,early noninvasive diagnosis, prompt surgical intervention, and progress in anesthesia and critical car support,the mortality rate remains unacceptably high (45–70%) in patients who arrive to a vascular center [5– whereas there is a community mortality rate of up to 90 [1, 2]. In a recent report, a gradual decrease in the oper ative mortality rate was achieved, from 48% in the 1980 to 41% in the past 2 years [6]. New operative technique have been tried, with limited success, to improve this dismaloutcome,but OS currently remainsthe gold standard of treatment [1]. The introduction of EVAR for asymptomatic AAA has added another approach that is considered appealin for the treatment of rAAA, with promising results pub- lished by pioneering centers [5, 8–10]. This reportdescribes our preliminary experience in the endovascular management of 25consecutive patien who had rAAA from 2001 through 2004. Materials and methods Since 2001, every patient who had suspected rAAA was assessed for EVAR after admission to the emergency department. In this series,all patients who had symp- tomatic AAA without any clinical or radiologic signs of rupture were excluded. The management team included senior vascular surgeon and an interventional radiolo- gist;in addition,other personnel (e.g.,anesthesiologist, anesthesiology nurses, and emergency staff) were in- Correspondence to: P. Castelli; email: patrizio.castelli@uninsubria.it ª Springer Science+Business Media, Inc. 2005 Published online: 15 March 2005 A bdominal I maging Abdom Imaging (2005) 30:263–269 DOI: 10.1007/s00261-004-0272-6