Infrarenal abdominal aortic aneurysm: Acute treatment of rupture

Abstract

The feasibility and efficacy of elective endovascular abdominal aortic aneurysm (AAA) repair are well established. Endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) is being performed with increasing frequency. Early international experiences enhanced the understanding of optimal intervention and aided in recognition and management of endovascular-related complications such as abdominal compartment syndrome, which contributes to early postoperative morbidity and mortality. The advantages of endovascular over open repair are more profound in the setting of aneurysm rupture, where the morbidity and mortality of open repair remains quite high. Endovascular repair of rAAAs offers multiple advantages such as decreased blood loss, minimization of fluid shifts, reduction of hypothermia, and decreased anesthetic requirements. This is especially true with the use of management algorithms that include hypotensive hemostasis, supraceliac balloon occlusion, streamlined preoperative imaging, and improved logistics in emergent endograft utilization. This chapter aims to demonstrate the use of endovascular repair in the setting of rAAA, including technical strategies for addressing challenging access anatomy.