The Role of Endovascular and Hybrid Procedures in the Management of Emergent Aortic Pathology: Experience at a Tertiary Care Center.

Objective: The purpose of this study was to evaluate the utility of endovascular and hybrid procedures to treat emergent aortic pathology.
Methods: Between July 2004 and September 2007, 137 endoluminal repairs of abdominal (101/137, 74%) and thoracic (36/137, 26%) aorta were performed. Of these, 13(9%) repairs were performed emergently. Demographic data, co-morbidities, device selection, complications and length of stay (LOS) were retrieved from a prospectively acquired vascular registry.
Results: There were 7(54%) thoracic aorta transections, 1(8%) thoracic aorta pseudoaneurysm 2(16%) ruptured thoracic, 1(8%) ruptured thoracoabdominal, and 2(16%) ruptured abdominal aneurysms. The mean age was 57.5 years (range 21-85, 11M/2F). Abdominal aortas were treated with the GORE Excluder device (2/2). The ruptured thoracoabdominal aneurysm was treated in a hybrid approach with debranching of visceral vessels and endograft placement (GORE/TAG). The thoracic aortic lesions were excluded with GORE/TAG device (7/9), the AneuRx cuffs (3/9) and COOK aortic cuffs (1/9). Spinal drainage was possible in only 1/11 patients. Patients were followed with spiral CT at 1 and 6 months and biannually thereafter. Mean follow-up was 12.2 months (range1-33months). All procedures were technically successful without conversions to open repair. Median LOS was 4 days (range2-22d). Morbidities included pneumonia (1/11,8%) and groin hematoma (1/11,8%). No MI, CVA, or paraplegia occurred. One typeII endoleak from the subclavian artery that resolved during follow-up was reported. The mortality rate was 8%(1/11) in a patient with concomitant traumatic injuries.
Conclusion: Endovascular stent grafting of the thoracic and abdominal aorta and hybrid approach procedures for visceral artery involvement are an alternative and can be performed with high technical success in acute aortic emergencies at a tertiary care center, with good short and mid-term results.