Contemporary Early and Long-Term Results of Open Repair for Ruptured and Symptomatic Unruptured Infrarenal AAA. Single Center Experience.

BACKGROUND: Observational studies have shown a reduced short-term mortality and increased long-term survival of EVAR over OR in the treatment of ruptured Infrarenal Abdominal Aortic Aneurysm (IAAA). Until now, none of the RCT has gained the result to demonstrate this superiority. Moreover, contemporary reports about results of OR of rIAAA are poor. METHODS: The study is observational and retrospective according to STROBE statement. The patients, unselected and strictly consecutive, were operated in urgency/emergency between 2007 and 2012. All had a preoperative CT angiography. Patients' characteristics, presentation, intraoperative and postoperative details were analyzed to identify factors that can affect the outcome. Considering the small number of events and the exploratory nature of the analyses, only univariate models were fit. RESULTS: One hundred five patients were treated in urgency/emergency setting because of symptomatic. The patients have been divided into two subgroups, based on lesion findings: 75 patients had ruptured IAAA (group A) and 30 patients had unruptured symptomatic IAAA, with CT findings of impending rupture (group B). Intraoperative, perioperative, and in-hospital mortality was respectively 0.9%, 8.6%, and 15.2%, with no difference between the groups. Unique predictors of 30-day mortality were transfusions, major and minor complications. Cumulative follow-up time was 455 person-years. Overall survival was not different between the groups. Predictors of late mortality were: age, creatinine at presentation, adjunctive procedures, length of in-hospital stay, any intraoperative complications, any perioperative complications, any major complication, and postoperative AKI. CONCLUSIONS: An experienced vascular team can achieve very good results in OR of ruptured IAAA, entirely comparable to EVAR. We are still far from a scientifically robust demonstration of the superiority of EVAR over OR in the treatment of ruptured IAAA.

Endovascular Exclusion of Aortobronchial Fistula and Distal Anastomotic Aneurysm after Extra-Anatomic Bypass for Aortic Coarctation.

The treatment of choice for aortic coarctation in adults remains open surgical repair. Aortobronchial fistula is a rare but potentially fatal late sequela of surgical correction of isthmic aortic coarctation via the interposition of a graft. The endovascular treatment of aortobronchial fistula is still under discussion because of its high risk for infection, especially if the patient has a history of cardiovascular prosthetic implantation. Patients need close monitoring, most notably those with secondary aortobronchial fistula. We discuss the case of a 65-year-old man who presented with the combined conditions, and we briefly review the relevant medical literature.