1. Endovascular Treatment of Acute Aortic Emergencies: Early Results Badr Aljabri, MD, FRCSC King Khalid University Hospital Riyadh, Saudi Arabia

2. EVAR and Aortic Emergency To evaluate early results of EVAR used in different Aortic Emergencies King Khalid University Hospital, Riyadh

3. Methods From prospective collected data of consecutive patients with Acute Aortic Emergencies (AAE) treated with EVAR February 2007- January 2008

4. Methods Preoperative multi-planer enhanced computed tomography with 2.5 mm cuts. All done under GA. Stent grafts were introduced through a common femoral artery cut down.

5. Methods Back-up meier wire Angiography cath through right brachial artery

6. 22 EVAR February 2007- January 2008 17 Thoracic 4 Abdominal 1 Hybrid

7. 10 AAE 5 Blunt traumatic thoracic aorta ruptures 4 Ruptured true thoracic aortic aneurysms 1 Ruptured proximal anastomotic aortic psudoaneurysm

8. Results 13 stent grafts implanted 9 Males : 1 Female mean age of 45 years (22– 73 years) Stent graft diameter 26-34 mm

9. Number of patients Number of stents Technical success rate % Left SCA Coverage 30-day mortality rate (%) Complications Blunt Thoracic Rupture 55100300 Ruptured true thoracic aortic aneurysms 4710002 (50)1MI Ruptured proximal anastomotic aortic psudoaneurysm 11100NA00 Total 101310032 (20)1 MI

10. Results No paraplegia or stoke 1 Access related complication

11. Case review

12. Ruptured true thoracic aortic aneurysm 65 year old male patient, HTN Sever back pain No history of trauma Referred with TAA for further management

16. Ruptured proximal anastomotic aortic psudoaneurysm 52 year old male patient HTN, NIDDM,ESRD on hemodialysis Aorto-bifemoral bypass 6 years ago ACS with left ventricular aneurysm Abdominal pain + pulsatile tender mass Cardiac cath

19. Blunt traumatic thoracic aorta rupture 23 year old male patient Head-on collusion MVA Multiple fractures both upper and lower limbs and small liver laceration CXR Enhanced CT

22. 17 series 1109 patients 538 (48.5%) TEVAR Significant reduction in Mortality Neurological injury Subgroup analysis

23. Retrospective review 74 patients 35 open VS 39 TEVAR 30 day mortality 20% surgical group 7.7% TEVAR

24. 30 patients 2 (6.6%) 30-day mortality 1 stroke No paraplegia

25. Conclusion Endovascular stent graft is an effective treatment option for an acute aortic emergencies particularly those who present with traumatic ruptures. Long-term follow-up is required to confirm its durability

26. Thank You