Endovascular grafts and other catheter-directed techniques in the management of ruptured abdominal aortic aneurysms.

Abdominal aortoiliac aneurysms that are ruptured and treated with open surgical repair have high morbidity and mortality rates. We have employed endovascular approaches to treat this entity since 1994. Patients with presumed ruptured aortoiliac aneurysms were treated with restricted fluid resuscitation (hypotensive hemostasis), transport to the operating room, placement under local anesthesia of a brachial or femoral guidewire into the supraceliac aorta and arteriography. If aortoiliac anatomy was suitable, an endovascular graft repair was performed. If the anatomy was unfavorable, the aneurysm was repaired in a standard open fashion. Only if circulatory collapse occurred was a supraceliac balloon placed and inflated using the previously positioned guidewire. Of 36 patients so managed, 30 underwent endovascular graft repair and six required open repair. Four patients died within 30 days (operative mortality = 11%). Only 10 patients required supraceliac balloon control. Endovascular grafts, when combined with hypotensive hemostasis and other endovascular techniques, including proximal balloon control, may improve treatment outcomes with ruptured abdominal aortoiliac aneurysms. These techniques should become widely used for the treatment of ruptured aneurysms.