Mortality for open repair of ruptured AAAs remains high (40-55%) with additional high rates of morbidity. Improvements in perioperative care and surgical technique, while valuable, have not substantially altered these high rates. The widespread adoption of endovascular AAA repair (EVAR) offers the chance to improve outcomes of treatment for ruptured AAAs. This video will show several cases of high risk patients with ruptured AAAs treated successfully by EVAR, and in a model, outline strategies, techniques and adjuncts for accomplishing the procedure effectively in different circumstances - especially when patients are unstable. It will also outline a general approach for dealing with this often emergent entity.

Three cases demonstrating these points will be presented. In an in vitro glass model, techniques will be shown for placing large sheaths, occlusion balloons and a Cook-Xenith modular aortoiliac endograft.

The general approach to endovascular treatment of this entity must include surgeons who are endocompetent and capable of performing elective EVAR skillfully, and the setting up of equipment which includes appropriate sheaths, balloons, graft components, converters and occluders. The location of this equipment must be known to the surgeons and readily available. Planning, preparation and rehearsal must precede performance of actual procedures.

These approaches, strategies, techniques and adjuncts should lead to improved treatment outcomes for ruptured AAAs.