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Abstract: Rupture of a thoraco-abdominal aortic aneurysm (TAAA) is usually lethal. Patients with contained ruptures, who reach the hospital, have traditionally been subjected to open reconstructive surgery. However, especially in older patients, open surgery has a high mortality and morbidity rate. Visceral hybrid procedures (VHPs) can provide an alternative in this high-risk patient group. We present a literature review of VHPs with a focus on acute TAAAs. [Copyright &y& Elsevier]

Purpose: To assess interobserver and intraobserver agreement on presence of rupture and determining suitability for endovascular repair (EVAR) on CT angiography (CTA) of patients with a suspected ruptured abdominal aortic aneurysm (RAAA). Methods: For the Amsterdam Acute Aneurysm study, a randomised multicenter trial (ISRCTN66212637), we register all patients with suspected RAAA in the Amsterdam region. For the current analysis 51 consecutive patients were included from this prospective database. Pre operative CT scans were assessed twice with a six-week interval by three vascular surgeons and two interventional radiologists. Variables recorded were presence of rupture, diameter and length of the infrarenal aortic neck, diameters of both iliac arteries and final judgement on anatomical suitability for EVAR. Kappa values for dichotomous outcomes were calculated as a measure of agreement above chance. Continuous outcomes were investigated by calculating the intraclass correlation coefficient (ICC) and by Bland-Altman plots. Results: For presence of rupture group kappa was 0.59 (CI: 0.42–0.77). The group kappa of suitability for EVAR was 0.38 (CI: 0.24–0.51). The ICC for diameter and length of the infrarenal aortic neck and diameters of left and right iliac arteries were 0.40 (CI: 0.26–0.56), 0.47 (CI: 0.32–0.62), 0.61 (CI: 0.48–0.74) and 0.35 (CI: 0.21–0.50) respectively. The Bland-Altman plots confirmed the large variation among observers. Intraobserver kappa ranged from 0.57–0.78 for presence of rupture and 0.40–0.80 for suitability for EVAR. Conclusion: Moderate interobserver agreement was found for presence of rupture and fair agreement for suitability for EVAR. Intraobserver agreement ranged from moderate to almost perfect. Based on this data, optimization of the protocol is mandatory to identify uniform measuring techniques of well defined anatomical criteria for endovascular repair of ruptured aneurysms. [Copyright &y& Elsevier]

We present 2 cases of ruptured true aneurysms of the pancreaticoduodenal arcade, underscoring the role of transcatheter arterial embolization (TAE) as the initial treatment of choice in pancreaticoduodenal arcade aneurysm. Ruptured true aneurysms of the pancreaticoduodenal artery (PDA) are uncommon and few cases have been reported, whereas false aneurysms are seen more often. The first patient we describe is a 63-year-old woman with an aneurysm of the PDA initially treated by TAE. The second case is a 67-year-old woman with an aneurysm of the inferior PDA post-operatively treated by TAE. In both patients TAE via a combined superior mesenteric artery and celiac axis approach was successful. Follow-up contrast-enhanced computed tomography showed prolonged occlusion of both aneurysms. A review of the literature concerning TAE supports our experience that TAE of ruptured aneurysms of the pancreaticoduodenal arcade, when feasible, is at least as effective as conventional surgery, but with lower morbidity and mortality. Therefore, TAE should be the initial treatment of choice in this group of patients. [ABSTRACT FROM AUTHOR]