Endovascular repair for acute symptomatic and ruptured abdominal aortic aneurysms.

Since the introduction of endovascular repair of abdominal aortic aneurysm, an increasing proportion ofelective asymptomatic patients have been found to be suitable for endovascular repair despite uncertainties over long-term durability and cost benefit. However, one group of patients whose recovery would most likely be improved and in whom postoperative hospital stay would be reduced by this technique are those who present with an acutely symptomatic or leaking abdominal aortic aneurysm. emergency open repair of these patients are associated with significant mortality rates of approximately 20% and 50% respectively.1 Those who survive may have a protracted recovery, requiring prolonged management in an intensive care unit. The endovascular technique avoids an abdominal incision and involves the intraluminal placement of stem-grafts via surgically exposed femoral arteries. The graft, which is preloaded in a plastic sheath, is advanced over guidewires up the femoral arteries until it is immediately distal to the lower of the two renal arteries. Once in position, the graft is released from the sheath and extensions into the iliac arteries are then attached to the main body of the graft through additional delivery sheaths (Figure 1). The stem-grafts are self-expanding and will fill to exclude the aneurysm. Here we report three patients, who presented with acute symptomatic infrarenal abdominal aortic aneurysms, one of which was confirmed to have a contained leak on CT scan. CASE REPORT The first patient was a 76 year old man who presented to a district general hospital with pain in the left flank radiating to the groin. He had a documented history of valvular and ischaemic heart disease, atrial fibrillation