Article Sidebar
Views PDF: 211
Management of ruptured abdominal aortic aneurysm with unstable hemodynamic, from admission to intensive care unit: case report and literature review
Main Article Content
Abstract
Background: Ruptured abdominal aortic aneurysm is an acute haemorrhage from the aneurysm which leads to accumulation of blood in retroperitoneal and/or intraperitoneal cavity. Endovascular intervention has been applied recently and is preferred choice to improve mortality and complications. However, ruptured abdominal aortic aneurysm is still a true emergency. Organizing an effective and coordinated effort of a professional team to approach and follow-up theses patients after intervention is essential to provide optimal results.
Objectives: To demonstrate the approach of ruptured abdominal aortic aneurysm in a hemodynamically unstable patient in the emergency setting, and display the process of intervention and management post-intervention in a cardiac intensive care unit, and provide a literature review
Methods: Case report of a successful endovascular intervention with double-balloon technique, treating ruptured abdominal aortic aneurysm at University of Medicine and Pharmacy Hospital at Ho Chi Minh City.
Results: A 65-year-old male was admitted to the hospital because of abdominal pain which had lasted 3 days. Computed tomography results showed a ruptured infrarenal abdominal aortic aneurysm. The patient underwent endovascular intervention repair using double-balloon technique. He was monitored and treated of intraabdominal hypertension post-intervention. The patient was discharged on the eighth postoperative day, in stable condition.
Conclusion: Treatment of ruptured abdominal aortic aneurysm with endovascular intervention is an effective and safe method with few complications. A coordinated team effort with standardized protocol, well-trained staffs, and sufficient intervention tools is required for success.
Article Details
Keywords
Endovascular intervention, Ruptured abdominal aortic aneurysm, Unstable hemodynamic, Aortic balloon occlusion
References
2. Laine MT, Laukontaus SJ, Kantonen I, Venermo M. Population-based study of ruptured abdominal aortic aneurysm. Br J Surg. 2016;103(12):1634-9.
3. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366-74.
4. Dua A, Kuy S, Lee CJ, Upchurch GR, Jr., Desai SS. Epidemiology of aortic aneurysm repair in the United States from 2000 to 2010. J Vasc Surg. 2014;59(6):1512-7.
5. Hinchliffe R, Bruijstens L, MacSweeney S, Braithwaite B. A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm–results of a pilot study and lessons learned for future studies. European Journal of Vascular and Endovascular Surgery. 2006;32(5):506-13.
6. Mayer D, Pfammatter T, Rancic Z, Hechelhammer L, Wilhelm M, Veith FJ, et al. 10 years of emergency endovascular aneurysm repair for ruptured abdominal aortoiliac aneurysms: lessons learned. Annals of Surgery. 2009;249(3):510-5.
7. Desgranges P, Kobeiter H, Katsahian S, Bouffi M, Gouny P, Favre J-P, et al. ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): a French randomized controlled trial of endovascular versus open surgical repair of ruptured aorto-iliac aneurysms. Journal of Vascular Surgery. 2015;62(3):789.
8. Investigators IT, Investigators IT, Braithwaite B, Cheshire NJ, Greenhalgh RM, Grieve R, et al. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial. European heart journal. 2015;36(31):2061-9.
9. Reimerink JJ, Hoornweg LL, Vahl AC, Wisselink W, van den Broek TA, Legemate DA, et al. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg. 2013;258(2):248-56.
10. Members WC, Isselbacher EM, Preventza O, Hamilton Black III J, Augoustides JG, Beck AW, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2022;80(24):e223-e393.
11. Văn Quảng N, Quyết Tiến T. Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và kết quả sớm điều trị phình động mạch chủ bụng dưới thận bằng can thiệp nội mạch. Tạp chí Y học Việt Nam. 2021;501(1).
12. Ngọc Thắng D, Minh Tứ B, Duy Hồng Sơn P. Kết quả sớm điều trị phồng động mạch chủ bụng dưới thận bằng phẫu thuật có kế hoạch tại Bệnh viện Hữu nghị Việt Đức giai đoạn 2018 - 2020. Tạp chí Y học Việt Nam. 2022;515(2).
13. Ước NH, Huy NC, Thắng DN, Mạnh NH, Sơn PDH. Kết quả điều trị phẫu thuật vỡ phồng động mạch chủ bụng dưới thận tại Bệnh viện Hữu nghị Việt Đức. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam. 2021;34:62-70.
14. Azhar B, Patel SR, Holt PJ, Hinchliffe RJ, Thompson MM, Karthikesalingam A. Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. J Endovasc Ther. 2014;21(4):568-75.
15. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2.
16. Hambly PR, Dutton RP. Excess mortality associated with the use of a rapid infusion system at a level 1 trauma center. Resuscitation. 1996;31(2):127-33.
17. Dick F, Erdoes G, Opfermann P, Eberle B, Schmidli J, von Allmen RS. Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg. 2013;57(4):943-50.
18. Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial. Bmj. 2017;359:j4859.
19. Antoniou GA, Georgiadis GS, Antoniou SA, Pavlidis P, Maras D, Sfyroeras GS, et al. Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair. J Vasc Surg. 2013;58(4):1091-105.
20. Baderkhan H, Goncalves FM, Oliveira NG, Verhagen HJ, Wanhainen A, Bjorck M, et al. Challenging Anatomy Predicts Mortality and Complications After Endovascular Treatment of Ruptured Abdominal Aortic Aneurysm. J Endovasc Ther. 2016;23(6):919-27.
21. Badger SA, Harkin DW, Blair PH, Ellis PK, Kee F, Forster R. Endovascular repair or open repair for ruptured abdominal aortic aneurysm: a Cochrane systematic review. BMJ Open. 2016;6(2):e008391.
22. Ali MM, Flahive J, Schanzer A, Simons JP, Aiello FA, Doucet DR, et al. In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair. J Vasc Surg. 2015;61(6):1399-407.
23. Jonker FH, Verhagen HJ, Mojibian H, Davis KA, Moll FL, Muhs BE. Aortic endograft sizing in trauma patients with hemodynamic instability. J Vasc Surg. 2010;52(1):39-44.
24. Karkos CD, Papadimitriou CT, Chatzivasileiadis TN, Kapsali NS, Kalogirou TE, Giagtzidis IT, et al. The Impact of Aortic Occlusion Balloon on Mortality After Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: A Meta-analysis and Meta-regression Analysis. Cardiovasc Intervent Radiol. 2015;38(6):1425-37.
25. Nakayama H, Toma M, Kobayashi T, Ohno N, Okada T, Ueno G, et al. Ruptured Abdominal Aortic Aneurysm Treated by Double-Balloon Technique and Endovascular Strategy: Case Series. Ann Thorac Cardiovasc Surg. 2019;25(4):211-4.
26. Vinh BĐA, Tuấn LQA, Thịnh VH, Chương PTV, Thanh NVT, Nam NH, et al. Hội chứng chèn ép khoang bụng sau can thiệp nội mạch điều trị vỡ phình động mạch chủ bụng: Báo cáo trường hợp lâm sàng và tổng quan y văn. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam. 2022;39:7-17.