Introduction and Aim of Work - The observations of rupture of aortic aneurysms, previously treated with endoprosthesis, have increased in recent years, for the most frequent use of endovascular exclusion of aneurysms (EVAR). The differences in clinical presentation and therapeutic approach must be recognized and evaluated in the treatment of ruptures after EVAR. Materials and Methods - Starting from the description of a clinical case, in the light of recent data reported in the literature, risk factors, clinical characteristics and surgical techniques are considered, which have to be considered in this increasing pathology. Discussion - The treatment of abdominal aortic aneurysms by exclusion with endograft has been gradually extending in recent years. The exclusion of the aneurysmal sac through the stent graft is intended to prevent progressive dilatation and aneurysm rupture. Despite the improvements in arterial endoprosthesis, with better adaptation to the morphology of the aneurysm and most valid fixation, recent articles report, about aneurysms treated with EVAR, an incidence of late rupture of 1, 5% per year. Among the various factors that cause such breakage, are statistically significant in the first place the presence of first and third type endoleak, then endoprosthesis migration and increase in the diameter of the aneurysm. In contrast to the rupture of aortic aneurysm not previously treated, the break after EVAR can evenctually stop by tamponade, for the presence endograft and smaller pressures inside the aneurysm sac. The classic symptoms of acute anemia and hypotension may lack misleading prompt diagnosis of the condition of "cracking" of the aneurysm, making it particularly insidious the clinical picture and therefore more dangerous a break down into two stages. Conclusions – Although rare, the rupture of aortic aneurysm after EVAR is increasing. The clinical picture can be deceptive, for the eventual plugging and breakage in two stages. Several expedients of surgical technique are useful tools to improve the handling of this pathology.

Introduzione e Scopo del Lavoro - Le osservazioni di rottura di aneurisma aortico, trattato in precedenza con endoprotesi, sono aumentate negli anni più recenti, per l’uso più frequente della metodica di esclusione endovascolare degli aneurismi (EVAR). Le differenze nella presentazione clinica e nell’approccio terapeutico devono essere conosciute e valutate nel trattamento di rotture dopo EVAR. Materiali e Metodi - Partendo dalla descrizione di un caso trattato, vengono considerati, alla luce dei dati riportati nella recente letteratura, i fattori di rischio, le caratteristiche cliniche e le tecniche chirurgiche particolari, da adottarsi nel trattamento di questa patologia di ormai meno raro riscontro. Discussione - Il trattamento degli aneurismi dell’aorta addominale mediante esclusione con endograft è andato progressivamente estendendosi negli ultimi anni. L’esclusione della sacca aneurismatica mediante stent graft ha il fine di impedire la progressiva dilatazione e rottura dell’aneurisma. Nonostante i miglioramenti nelle endoprotesi arteriose, con adattamento alla morfologia variabile dell’aneurisma e maggior fissazione dell’endograft, è riportata, su aneurismi trattati con EVAR, un’incidenza di rottura tardiva dell’1,5% per anno. Tra i vari fattori che causano tale rottura, risultano statisticamente significativi in primo luogo la presenza di endoleak di primo e terzo tipo, quindi la migrazione dell’endoprotesi e l’aumento nel diametro dell’aneurisma. A differenza della rottura di aneurisma aortico non trattato in precedenza, la rottura dopo EVAR può più facilmente tamponarsi, per la presenza dell’endograft e le pressioni più ridotte all’interno della sacca aneurismatica. La sintomatologia classica di ipotensione ed anemizzazione acuta può quindi mancare e può protrarsi la condizione di “fissurazione” dell’aneurisma, rendendo particolarmente subdolo il quadro clinico e quindi maggiormente pericolosa la rottura in due tempi. Conclusioni - La rottura di aneurisma aortico dopo EVAR è sempre meno rara. Il quadro clinico può essere ingannatore, per l’eventuale tamponamento e rottura in due tempi. Svariati accorgimenti di tecnica chirurgica facilitano il trattamento di questa patologia.

Mingazzini, P., Camesasca, V., Deleo, G., Liloia, A., Benatti, C. (2007). La rottura in due tempi dell’aneurisma dell’aorta addominale trattato con precedente endoprotesi. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 14(2), 137-137.

La rottura in due tempi dell’aneurisma dell’aorta addominale trattato con precedente endoprotesi

MINGAZZINI, PAOLO;
2007

Abstract

Introduction and Aim of Work - The observations of rupture of aortic aneurysms, previously treated with endoprosthesis, have increased in recent years, for the most frequent use of endovascular exclusion of aneurysms (EVAR). The differences in clinical presentation and therapeutic approach must be recognized and evaluated in the treatment of ruptures after EVAR. Materials and Methods - Starting from the description of a clinical case, in the light of recent data reported in the literature, risk factors, clinical characteristics and surgical techniques are considered, which have to be considered in this increasing pathology. Discussion - The treatment of abdominal aortic aneurysms by exclusion with endograft has been gradually extending in recent years. The exclusion of the aneurysmal sac through the stent graft is intended to prevent progressive dilatation and aneurysm rupture. Despite the improvements in arterial endoprosthesis, with better adaptation to the morphology of the aneurysm and most valid fixation, recent articles report, about aneurysms treated with EVAR, an incidence of late rupture of 1, 5% per year. Among the various factors that cause such breakage, are statistically significant in the first place the presence of first and third type endoleak, then endoprosthesis migration and increase in the diameter of the aneurysm. In contrast to the rupture of aortic aneurysm not previously treated, the break after EVAR can evenctually stop by tamponade, for the presence endograft and smaller pressures inside the aneurysm sac. The classic symptoms of acute anemia and hypotension may lack misleading prompt diagnosis of the condition of "cracking" of the aneurysm, making it particularly insidious the clinical picture and therefore more dangerous a break down into two stages. Conclusions – Although rare, the rupture of aortic aneurysm after EVAR is increasing. The clinical picture can be deceptive, for the eventual plugging and breakage in two stages. Several expedients of surgical technique are useful tools to improve the handling of this pathology.
Abstract in rivista
Abdominal Aortic Aneurysm, Aortic Stent-Graft, Surgical Conversion, Rupture
Aneurisma dell’Aorta addominale, Endoprotesi Aortica, Conversione, Rottura
Italian
2007
14
2
137
137
none
Mingazzini, P., Camesasca, V., Deleo, G., Liloia, A., Benatti, C. (2007). La rottura in due tempi dell’aneurisma dell’aorta addominale trattato con precedente endoprotesi. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 14(2), 137-137.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/14827
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