Supraceliac Aortic Clamping for Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Short Aortic Neck Length

Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, not only disturbs the means to an expeditious repair, but may also increase morbidity and mortality. In the present study, we aimed to evaluate the efficacy of supraceliac aortic clamping for improving surgical outcomes for patients with ruptured abdominal aortic aneurysm, who have a short aortic neck length. Method: Between April 2010 and September 2015, eighteen patients underwent emergent open surgical repair of ruptured abdominal aortic aneurysm. Eight patients with a short aortic neck length underwent supraceliac aortic clamping, and 10 underwent infrarenal aortic clamping. Results: The mean supraceliac aortic clamping time was 30 ± 7 minutes. There was 1 operative death in the infrarenal aortic clamping group due to respiratory failure, and the overall operative mortality was 6%. There were no significant differences between the 2 groups with respect to postoperative complication rates or mortality. Furthermore, there were no significant differences in variables of renal function between the 2 groups, through-out the study period. Conclusion: Supraceliac aortic clamping was associated with minimal mortality and morbidity, but not with harmful effects on postoperative renal function. Thus, supraceliac aortic clamping can be safely applied for ruptured abdominal aortic aneurysm with short aortic neck length.

A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm （rAAA） obtain the greatest benefit from endovascular repair （EVAR）, convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair （OSR）. Methods A search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods. Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA （435 EVAR and 778 OSR） would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment （OR=1.81, P=0.01）, while there are more patients with hemodynamic instability before treatment in OSR group （OR=1.53, P=0.031）. Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR （weighted mean difference （WMD） 1500 ml, P=0.014）. The endovascular method was associated with a shorter stay in intensive care （WMD 2.34 days, P 〈0.001） and a shorter total post- operative stay （WMD 6.27 days, P 〈0.001）. The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group （OR=0.48, P 〈0.001 and OR=0.28, P=0.043, respectively）. The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 （95% confidence interval （CI） 0.41-0.70, P 〈0.001）. There was not, however, any significant reduction in the medium-long all-cause mortality rate （HR=1.13, P=0.381） and re-intervention rate （OR= 2.19, ,~=-0.243） following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak （OR=0.33, P=0.039） at late follow-up period. Conclusions On the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.