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Background Treatment of ruptured abdominal aortic aneurysms (rAAAs) is still burdened by high morbidity and mortality. Although endovascular aortic repair (EVAR) offers encouraging results in elective setting, its role as first-line strategy to treat rAAA is still debated. Our aim was to compare early and late outcomes in patients undergoing open surgical repair (OSR) versus EVAR for rAAAs. Methods A retrospective review of data extracted from medical records identified 105 consecutive patients with rAAA who were submitted to open or endovascular repairs from 2008 to 2016. The primary end point was to assess the rAAA-related mortality in the immediate postoperative period, within 1 month and 1 year after OSR, and EVAR; secondary endpoints included the following: length of stay, AAA-related postoperative complications such as acute limb ischemia, myocardial infarction, renal and respiratory failure, and rAAA-related re-interventions. Statistical analysis was performed using the Fisher exact test, χ2 test, and logistic regression calculations. Early and midterm survival rates were assessed with Cox model. Results Of the 105 patients with rAAA, 70.48% underwent OSR including 41.89% which was hemodynamically (Hd) unstable and the remaining 29.52% was submitted to rEVAR. (all Hd stable). Compared with EVAR group, the OSR group had a higher rAAA-related mortality rate for both Hd stable and Hd unstable patients: 18.92% vs. 6.45% at 24 hr; (P = 0.185) 39.19% vs. 19.35% at 30 days (P = 0.082); 44.59% vs. 38.71% at 1 year (P = 0.734) If only Hd stable patients were considered, mortality following OSR and EVAR was as follows: 6.98% vs. 6.45% at 24 hr (P = 0.703); 27.91% vs. 19.35% at 30 days (P = 0.567); 32.56% vs. 38.71% at 1 year (P = 0.764). Mean length of stay for patients was 15 days after OSR and 10 days after rEVAR (P = 0.002). At 1-year follow-up, the overall rAAA-related complications incidence was higher in the rEVAR group than that in the OSR group (47.85% vs. 18.33%; P = 0.008); re-interventions were 18.33% in OSR group vs. 21.82% in EVAR group (P = 0.917). Cox model showed that instability and coronary artery disease were predictors of overall mortality of rAAAs. Conclusions EVAR does not independently reduce 1-year mortality in comparison with OSR in Hd stable patients. Urgent EVAR for rAAAs in unstable patients can be limited by logistical problems. It follows that patients selected for OSR have a more complex aortic anatomy and worse Hd status than those submitted to rEVAR. rEVAR burdened by a higher incidence of procedure-related complications than OSR. Reconfiguration of acute aortic services and establishment of standardized institutional protocols might be advisable for improvements in the management of ruptured AAA. A careful evaluation of whether the benefits of an endovascular strategy translate into long term benefit is needed before definitive conclusions can be drawn about the advantages of EVAR as first-line strategy for ruptured aneurysms.

The aim of this study is to present the treatment of a juxtarenal inflammatory aneurysm using a Nellix device (Endologix, Inc., Irvine, CA) to seal the entire aneurysmatic aorta combined with bilateral iliac–renal bypass using the Gore hybrid vascular graft (W. L. Gore & Associates, Inc., Flagstaff, AZ). A 63-year-old man was diagnosed with a 6-cm juxtarenal inflammatory aneurysm. It was initially decided to treat him with an aorto-aortic bypass and to revascularize the 2 renal arteries with “graft to renal artery bypass” using Gore hybrid vascular grafts. Due to the high intraoperative bleeding preparing the proximal neck and the tight adhesion of the aorta to the adjacent structures, we decided to change our plans and to treat the patient using the Nellix system combined with bilateral iliac–renal bypass using the Gore hybrid vascular grafts. Contrast computed tomography control at 1 month showed complete sealing of the aneurysm sac and patent iliac renal bypasses. The reported case demonstrated that the Nellix Endovascular Aneurysm Sealing system combined with Gore hybrid vascular grafts for bilateral iliac–renal bypass showed that it can be an effective modality for the treatment of juxtarenal, inflammatory aortic aneurysm and revascularization of the renal arteries from the distal iliac arteries.

Background Presenting the treatment of a juxtarenal aneurysm using a Nellix device combined with a chimney stent in a renal artery. Case Report A 72-year-old woman was diagnosed with a 5.5-cm bilobed juxtarenal aneurysm. She underwent successful aneurysm repair with the Nellix system combined with a chimney stent in the left renal artery. Angio computed tomography control showed complete sealing of the aneurysm sac and patent chimney stent. Conclusions Endovascular aneurysm sealing combined with chimney may be a valid way to treat juxtarenal aneurysms, and the conformable polymer-filled endobags may provide a durable seal around the chimney-graft preventing gutter formation.