Endoluminal repair of ruptured abdominal aortic aneurysms under local anesthesia: initial experience

Open surgical repair is the standard treatment for a ruptured infrarenal abdominal aortic aneurysm (rAAA). This approach is associated with mortality rates of up to 70%, with significant surgery-related morbidity among survivors. In selected patients, endoluminal repair (ER) of an rAAA under local anesthesia may allow emergent aneurysm repair with reduced perioperative stress, ideally resulting in improved outcomes. The authors report their initial experience using a commercially available bifurcated endoluminal stent-graft to treat patients with rAAA under local anesthesia. Five of 8 patients (63%) with rAAA in a 1-year interval (June 2000-May 2001) were treated with ER. Criteria for ER were the following: (1) suitable aortic anatomy based on preoperative computed tomography (CT) imaging and (2) a hemodynamic state not requiring immediate aortic control. Mean size of ER rAAAs was 8 cm. Four of 5 patients underwent ER under local anesthesia. All 5 ER patients survived the initial surgery, and 4 patients survived to discharge. The expired patient was a Jehovah's Witness who had a successful ER but was profoundly anemic postoperatively and refused transfusion. On postoperative CT imaging, no endoleaks were noted and no AAA enlargement had occurred. In a selected but significant subset of rAAA patients, emergent repair using a commercially available bifurcated endograft under local anesthesia is feasible, and clinical outcomes are acceptable. These promising initial results suggest that a further evaluation of the role of endoluminal repair in the treatment of ruptured infrarenal AAAs is warranted.