RESUMO
INTRODUCTION: Endovascular aortic repair (EVAR) of a ruptured abdominal aortic aneurysm (rAAA) has become a common approach. Hemorrhagic shock associated with the use of iodinated contrast medium (ICM) increases the risk of acute kidney injury (AKI). Theoretically, eliminating ICM from EVAR can decrease that risk. The aim of this pilot study was to analyze the feasibility and safety of emergent EVAR performed with the exclusive use of carbon dioxide (CO2) for a rAAA. METHODS: Since 2021, all consecutive rAAAs with hemorrhagic shock and suitable anatomical criteria for a standard endograft have been treated by EVAR with the exclusive use of CO2 using an automated CO2 injector (Angiodroid SpA, San Lazzaro di Savena, Italy). RESULTS: Eight percutaneous EVARs were performed under local anesthesia. Median age was 78 (interquartile range [IQR]=6) years, 5 patients were male. The technical success was 100%, the 30-day mortality was 25% (n=2), the median amount of administered CO2 was 400 (IQR=60) ml. The median change in serum creatinine level between admission, post-operative and 30-day values was an increase of 0.14 mg/dL and a decrease of 0.11 mg/dL, respectively. Post-operative AKI occurred in the two patients who died. All 6 surviving patients showed sac shrinkage >5 mm, and no reinterventions at a median follow-up of 10 months. CONCLUSIONS: Endovascular repair of rAAA with the exclusive use of CO2 as contrast agent is technically feasible and safe. Further studies are needed to determine whether CO2 increases survival rate and limits the progression of renal dysfunction after endovascular repair of rAAA. CLINICAL IMPACT: The recorded rate of post-operative AKI after endovascular repair of rAAA performed with the use of CO2 found in this pilot study was significantly lower than the one reported in the literature with the use of ICM. Our hyphotesis is that the use of CO2 during rEVAR might increase survival rate and limits the progression of renal dysfunction.
RESUMO
BACKGROUND: The aim of this study was to report long-term results of infrarenal abdominal aortic aneurysm (AAA) in a single tertiary Hospital. METHODS: One thousand seven hundred seventy-seven consecutive AAA repairs (2003-2018) were included. Primary outcomes were all-cause mortality, AAA-related mortality, reinterventions rate. Open repair (OSR) was offered in case the patient had a functional capacity ≥4 metabolic equivalents (MET), and a predicted >10 year life expectancy. Endovascular repair (EVAR) was offered in case of hostile abdomen, presence of anatomic feasibility for standard endovascular graft, and <4 MET. Sac shrinkage was defined as a reduction of both anterior-posterior and latero-lateral diameter of the sac of at least 5 mm at the last follow-up vs. the first post- operative follow-up imaging. RESULTS: Eight hundred twenty-eight (47%) OSRs and 949 (53%) EVARs were performed 90.6% (N.=1610) were male, mean age was 73.8 years. Mean follow-up was 79 (SD: 51) months. 30-day mortality was 0.7% (N.=6) and 0.6% (N.=6) for OSR and EVAR respectively (P=1). Long-term survival was better for OSR as expected by the selection criteria used (P<0.001), while AAA-related death was similar in the OSR vs. EVAR group (P=0.37); 664 (70%) sac shrinkages occurred at the last follow-up in the EVAR group. Freedom from reintervention was 97% and 96% at 1 year, 96.5% and 88.4% at 5 years, 95.8% vs. 81.7% at 10 years, and 94.6% vs.72.3% at 15 years for OSR and EVAR, respectively (P<0.001). The reintervention rate was significantly lower in the sac shrinkage vs. no-sac shrinkage subgroup and but higher than the OSR (P≤0.001). Any statistical difference was found for the survival outcome in case of sac shrinkage (P=0.1). CONCLUSIONS: Open repair of an infrarenal AAA had a lower reintervention rate than EVAR even in case of a shrinked sac at a long-term follow-up. Further studies with greater sample size are needed.
