“Multilevel” approach key to emergency endovascular repair


A “multilevel” approach is the key to improving outcomes for endovascular repair of ruptured aortic aneurysm, according to Mario Lachat of University Hospital Zurich, Switzerland.

Lachat said that different groups report short-term mortality following emergency endovascular repair ranging between five and 53%.

Addressing the CACVS congress in Paris, in January 2009, Lachat described various technical improvements, from technology and technique of implantation of stent grafts, to diagnostic imaging and logistics. It was improvements across the full range of care, he said, that enabled certain institutions to achieve such low mortality rates.

Many consider that as few as 20% of ruptured aneurysm patients are suitable for endovascular repair, Lachat said. Pushing the anatomical limits of the procedure means risking type 1a endoleaks and mid- to long-term secondary dislocations.

Lachat described “damage control” emergency endovascular repair was discussed as a strategy for managing this. Proximal banding, or other techniques, can be employed to achieve less-than-perfect results. Provided the patient stabilizes, this can be preferable to exposing the patients to the risks inherent in converting to open repair, said Lachat.

Using this technique, Lachat’s group say that they have been able to treat up to 88% of ruptured aneurysm patients with endovascular repair.

Lachat also hailed the contribution of hypotensive haemostasis, transfemoral supraceliac aortic balloon occlusion, and local anaesthesia.