Objective: To present our results and demonstrate advantages of rapid endovascular balloon occlusion (REBO) of the juxtarenal aorta in unstable patients with ruptured abdominal aortic aneurysm (rAAA).
Methods: Since 2006, all unstable patients with rAAA are immediately transferred to the operating room (OR). No computed tomography scan is performed once diagnosis is made on ultrasound examination. Instability is defined as systolic blood pressure less than 60 mm Hg, unconsciousness, cardiac ischemia, or intubation. Once arrived in the OR, a Reliant aortic balloon is introduced and inflated at the level of the renal arteries. Subsequently, an angiogram is made through the contralateral femoral artery in order to decide between open or endovascular repair (EVAR).
Results: Twelve patients with rAAA were defined as unstable. REBO was installed within 10 minutes after arrival in the OR. Aortic occlusion resulted in immediate hemodynamic stability. Five patients were suitable for EVAR. Seven patients had open repair. For these abdominal dissection was more careful since no instability was encountered. All patients survived the procedure except one. Mean stay on intensive care unit was 19.7 days for open group and 8.4 for EVAR.
Conclusions: REBO of the juxtarenal abdominal aorta by pc technique in unstable patients with rAAA resulted in a 17% 30-day mortality and a 100% 1-year event-free follow-up for survivors. With this technique, EVAR exclusion is still a valuable treatment. Exposure and decision making for the open group is easier to perform with less risk for additional damaging to neighboring structures during dissection since urgent cross-clamping is not necessary.
From the Departments of *Thoracic and Vascular Surgery, †Radiology, and ‡Emergency Medicine, University Hospital Antwerp, Edegem, Belgium.
Accepted for publication February 4, 2009.
Presented at the Annual Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, Boston, MA, June 11–14, 2008.
Address correspondence and reprint requests to Jeroen M. Hendriks, MD, PhD, Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Wilrijkstraat 10, b-2650 Edegem, Belgium; E-mail: email@example.com.