Ruptured Aortic Aneurysms from Endoleak : A Contemporary Rural Tertiary Care Center Experience
Dariam Cardentey Oliva, Brett Fowler, Michael M McNally, Scott L Stevens, Oscar H Grandas, Michael B Freeman, Ryan M Buckley, Joshua D Arnold, Mitchell H Goldman
University of Tennessee Medical Center, Knoxville, TN
BACKGROUND: Endoleak leading to aortic aneurym rupture is rare long-term complication after endovascular aortic aneurysm repair (EVAR). Treatment for endoleak after EVAR is specific to each type and include observation, endovascular and conversion to open repair. The aim of this study is to review the impact of patient distance to aortic treatment center and clinical outcomes with ruptured abdominal aortic aneurysms after EVAR from endoleaks at a rural tertiary care center.
METHODS: Between September 2021-2022, all patients who presented to a rural tertiary center with an endoleak after EVAR leading to aneurysm rupture were reviewed. Comorbidities and demographics, including enrollment in a surveillance protocol upon presentation and its relationship to the distance from the hospital were recorded. Primary endpoint was 30-day mortality. Secondary endpoints included hemodynamics on presentation, complications, and length of stay.
RESULTS: Within the 12-month study period, five patients underwent emergency surgical treatment for ruptured aortic aneurysm secondary to endoleak after previous endovascular repair. Average age was 76 years. All five patients were Caucasian males. Endoleak types leading to rupture included Type 1a(n=2), Type 1b(n=2), Type II(n=1) and Type III(n=1). Mean time to rupture was 7 years. One local patient had been under standard surveillance with an unremarkable CT scan 5 months prior to presentation. The second local patient was under surveillance and demonstrated at type II endoleak with aneurysm sac expansion over the last 3 years without intervention offered. The remainder of the patients (3/5) lived in remote areas and were not enrolled on a surveillance protocol upon presentation. Average distance from the hospital for all patients was 34.1 miles (range 8.4-57mi). Three patients not under surveillance protocol lived in remote areas over 50 miles from the hospital. The majority (80%) presented without hemodynamic compromise. Three patients underwent emergency endovascular repair and two underwent open surgical conversion. Complications included renal failure 60% (3/5), respiratory failure 40% (2/5), new onset atrial fibrillation 20% (1/5), and multiorgan system failure 20% (1/5). The average LOS was 4.4 days. 30-day mortality was 40% (2/5).
CONCLUSION: Aortic aneurysm rupture secondary to endoleak has documented poor clinical outcomes supported by this study. The impact of patient distance to aortic treatment center in EVAR surveillance has possible implications in treatment selection and warrants further study.
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