Stent-graft use in urgent and emergent AAA management

The use of stent grafts in the treatment of ruptured aortic aneurysm, abdominal (AAA) may reduce mortality associated with this process through its dramatic alteration of the surgical technique employed. Advantages of endovascular repair include the ability to perform the procedure under local anesthesia, decreased physiologic stress of avoiding a laparotomy and avoiding collateral damage during open repair. Criticisms of this technique include additional preoperative time spent obtaining appropriate imaging, the necessity for specialized products and personnel required to perform the procedure, and late complications such as abdominal compartment syndrome. Current data regarding a survival advantage appear favorable but flawed, highlighting the need for prospective randomized trial. Three trials are currently underway with the largest, the IMPROVE trial, the most likely to yield definitive evidence.