Abstract
Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent
surgical repair or medical management was the only treatment options. The development
of covered stent grafts has introduced a third approach in the care of these critical
patients. The clinical status of the patient and local physician expertise drive the
treatment modalities in the majority of cases. The goal of therapy in these patients
is to stabilize the patient as quickly as possible, establish maximum survival with
minimum morbidity, and provide a long lasting result. The endovascular approach has
become an acceptable treatment option in an increasing number of patients presenting
with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta.
Major factors influencing treatment include patient clinical status, characteristics
of the aorta, physician preference, institutional experience, and availability of
appropriate equipment. Planning, experience, and the ability to improvise effective
solutions are keys to the success of the procedure when endovascular techniques are
utilized. Three separate cases, requiring intraprocedural improvisation, are presented
followed by a review of the literature.
Keywords
ruptured aneurysm - emergent stent graft - EVAR - TEVAR - interventional radiology
