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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (6): 1052-1057. doi: 10.19723/j.issn.1671-167X.2024.06.017

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Effect of balloon occlusion combined with intra-sac injection of thrombin in the treatment of ruptured abdominal aortic aneurysm

Shilu ZHAO, Jingyuan LUAN*(), Qichen FENG, Qijia LIU, Guangxin YANG, Zichang JIA, Jinman ZHUANG   

  1. Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-05-15 Online:2024-12-18 Published:2024-12-18
  • Contact: Jingyuan LUAN E-mail:drluan@139.com
  • Supported by:
    Beijing New Health Industry Development Foundation(XM2023-04-001)

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Abstract:

Objective: To investigate the safety and effectiveness of balloon occlusion and intra-sac thrombin injection in the endovascular repair of ruptured abdominal aortic aneurysm. Methods: From October 2019 to October 2022, the clinical data of 16 patients with rAAA treated with balloon occlusion technique and intra-sac thrombin injection combined with EVAR were retrospectively analyzed, including 13 males and 3 females, aged 42-85 years, with a median age of 70.5 years. The time of preoperative first aid (from hospital arrival to operation start), average operation time, stay in intensive care unit (ICU), average hospitalization time, success rate of surgical treatment, perioperative (30 d) mortality rate, incidence of complications, the maximum diameter and volume change of the aneurysm were observed and recorded. Results: Among the 16 patients with ruptured abdominal aortic aneurysm, the technical success rate was 100.0% (16/16). One patient died of multiple organ dysfunction 6 hours after operation. The success rate of surgical treatment was 93.8% (15/16). The preoperative first aid time was (53.3±6.2) min, the average operation time was (89.9±17.1) min, the stay in the intensive care unit (ICU) was (1.7±0.8) d, and the average hospitalization time was (7.8±1.3) d. The intraoperative balloon occlusion time was (32.4±4.1) min. The postoperative renal function of all the patients had no significant deterioration compared with that preoperative. Abdominal compartment syndrome (ACS) occurred in 1 patient after operation, which improved after CT puncture and drainage. The median follow-up time was 36 months. During the follow-up period, 1 patient died of acute myocardial infarction 2 years after operation, and the remaining 14 patients survived. Among the 14 follow-up patients, 1 type Ⅱ endoleak occurred, and no other types of endoleak occurred. By the end of the follow-up, the maximum diameter of the aneurysm sac in 14 patients was significantly lower than that before operation [(44.6±8.0) mm vs.(66.0±15.5) mm, P < 0.001], and in 12 patients with CTA, the volume of the aneurysm sac was significantly shrunk than that before operation [(311.7±170.3) mm3 vs. (168.6±68.1) mm3, P < 0.05]. Conclusion: Balloon occlusion during endovascular repair is safe and effective in the treatment of ruptured abdominal aortic aneurysm; intraoperative thrombin injection of the aneurysm sac can significantly reduce the incidence of intraoperative and postoperative abdominal compartment syndrome and endoleak and, to a certain extent, improve the success rate of treatment.

Key words: Ruptured abdominal aortic aneurysm, Balloon occlusion, Thrombin, Endovascular repair

CLC Number: 

  • R654.3

Table 1

Changes of main monitoring indicators in perioperative period of 15 patients"

GroupAbdominal pain/Lmbodynia, n(%)Body temperature/℃, $\bar x \pm s$ Leucocyte/(×109/L), $\bar x \pm s$ Erythrocyte/(×109/L), $\bar x \pm s$ Hemoglobin/(g/L), $\bar x \pm s$ Serum creatinine/(μmol/L), $\bar x \pm s$
Non remission Partial remission Complete remission
Pre-operation 15 (100) 0 0 36.8±0.2 10.64±3.69 2.65±0.64 80.73±17.03 131.80±46.47
Post-operation (24 h) 5 (33) 7 (47) 3 (20) 37.8±0.6 11.11±4.28 2.96±0.49 87.20±12.77 119.60±33.62
Post-operation (48 h) 4 (27) 8 (53) 3 (20) 38.0±0.5 9.32±3.61 3.10±0.51 93.60±11.72 100.67±26.17
Post-operation (72 h) 3 (20) 7 (47) 5 (33) 37.3±0.3 8.34±3.59 3.33±0.49 101.00±3.12 93.67±17.68
Before discharge 0 (0) 0 (0) 15 (100) 36.7±0.1 7.38±1.28 3.68±0.56 114.00±8.71 77.47±13.10

Figure 1

Intra-sac thrombin injection for the treatment of endoleak after EVAR in a 77-year-old rAAA patient The patient undertook endovascular aneurysm repair (EVAR). After the stent grafts (Cordis InCraft) were all deployed, a type Iaendoleak (arrow) was confirmed by angiography (A). Then thrombin was injected through the preseted catheter (arrowhead). After thrombin injection, the endoleak was disappeared (B). By 1-year follow-up, no endoleak was found (C)."

Figure 2

Balloon occlusion combined with intra-sac injection of thrombin for treatment of rAAA in a 76-year-old patient The diagnosis of ruptured abdominal aortic aneurysm was confirmed by the CT angiogram (A). The maximum transverse diameter was 74.1 mm and the volume of the aneurysm sac was 259.4 mm3. The patient undertook urgent endovascular aneurysm repair (EVAR) while balloon temporarily occlusion of abdominal aorta (B). After the stent grafts (Medtronic Endurant) were all deployed, the thrombin was injected through the preseted catheter (arrow). No any endoleak was confirmed by the final angiography. The retroperitoneal hematoma was assimilated and no endoleak was foundduring the 6-month (C) and 1-year (D) follow-up. The maximum transverse diameter decreased to 57.8 mm and 42.7 mm and volume of the aneurysm sac shrank to 184.8 cm3and 109.2 cm3 by the 6-month (C) and 1-year (D) follow-up."

1 Reimerink JJ , van der Laan MJ .Systematic review and meta-analysis of population-based mortality from ruptured abdominal aortic aneurysm[J].Br J Surg,2013,100(11):1405-1413.
doi: 10.1002/bjs.9235
2 Amato B , Fugetto F .Endovascular repair versus open repair in the treatment of ruptured aortic aneurysms: A systematic review[J].Minerva Chir,2019,74(6):472-480.
3 Patelis N , Moris D .Endovascular vs. open repair for ruptured abdominal aortic aneurysm[J].Med Sci Monit Basic Res,2016,22,34-44.
doi: 10.12659/MSMBR.897601
4 McPhee J , Eslami MH .Endovascular treatment of ruptured abdominal aortic aneurysms in the United States (2001-2006): A significant survival benefit over open repair is independently associated with increased institutional volume[J].J Vasc Surg,2009,49(4):817-826.
doi: 10.1016/j.jvs.2008.11.002
5 Holt PJ , Karthikesalingam A .Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm[J].Br J Surg,2010,97(4):496-503.
doi: 10.1002/bjs.6911
6 Azhar B , Patel SR .Misdiagnosis of ruptured abdominal aortic aneurysm: Systematic review and meta-analysis[J].J Endovasc Ther,2014,21(4):568-575.
doi: 10.1583/13-4626MR.1
7 Rhudy AK , Patel S .Point-of-care ultrasound for identification of ruptured infrarenal abdominal aortic aneurysm[J].Echocardiography,2022,39(6):841-843.
doi: 10.1111/echo.15359
8 Lee KM , Choi SY .Effects of anatomical characteristics as factors in abdominal aortic aneurysm rupture: CT aortography analysis[J].Medicine (Baltimore),2017,96(25):e7236.
doi: 10.1097/MD.0000000000007236
9 Tadayon N , Mozafar M .In-hospital outcomes of ruptured abdominal aortic aneurysms: A single center experience[J].J Cardiovasc Thorac Res,2022,14(1):61-66.
doi: 10.34172/jcvtr.2022.02
10 Qin C , Chen L .Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: A meta-analysis[J].PLoS One,2014,9(1):e87465.
doi: 10.1371/journal.pone.0087465
11 Badger S , Forster R .Endovascular treatment for ruptured abdominal aortic aneurysm[J].Cochrane Database Syst Rev,2017,26(5):CD005261.
12 Badger S , Bedenis R .Endovascular treatment for ruptured abdominal aortic aneurysm[J].Cochrane Database Syst Rev,2014,21(7):CD005261.
13 Ciaramella MA , Ventarola D .Modern mortality risk stratification scores accurately and equally predict real-world postoperative mortality after ruptured abdominal aortic aneurysm[J].J Vasc Surg,2021,73(3):1048-1055.
doi: 10.1016/j.jvs.2020.07.058
14 Philipsen TE , Hendriks JM .The use of rapid endovascular balloon occlusion in unstable patients with ruptured abdominal aortic aneurysm[J].Innovations (Phila),2009,4(2):74-79.
doi: 10.1097/imi.0b013e3181a00bc9
15 Farooq MM , Freischlag JA .Effect of the duration of symptoms, transport time, and length of emergency room stay on morbidity and mortality in patients with ruptured abdominal aortic aneurysms[J].Surgery,1996,119(1):9-14.
doi: 10.1016/S0039-6060(96)80206-6
16 Raux M , Marzelle J .Endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes[J].J Vasc Surg,2015,61(2):304-308.
doi: 10.1016/j.jvs.2014.07.098
17 Bath J , Leite JO .Contemporary outcomes for ruptured abdominal aortic aneurysms using endovascular balloon control for hypotension[J].J Vasc Surg,2018,67(5):1389-1396.
doi: 10.1016/j.jvs.2017.09.031
18 Zhao SL , Xiong JP .Intra-sac injection of thrombin during endovascular aneurysm repair to remedy type Ⅱ endoleak and promote sac shrinkage[J].Vasc Endovascular Surg,2024,58(2):151-157.
doi: 10.1177/15385744231197457
19 Rubenstein C , Bietz G , Davenport DL , et al.Abdominal compartment syndrome associated with endovascular and open repair of ruptured abdominal aortic aneurysms[J].J Vasc Surg,2015,61(3):648-654.
doi: 10.1016/j.jvs.2014.10.011
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