Skip to main content

Advertisement

SpringerLink
Log in

Current treatment strategies for ruptured abdominal aortic aneurysm

  • REVIEW ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Ruptured abdominal aortic aneurysm (rAAA) represents one of the most challenging emergencies in surgery. Open repair (OR) is associated with relevant morbidity and mortality and has not been reduced significantly over the last decade. The introduction of endovascular aneurysm repair (EVAR) and its meanwhile common use in the treatment of rAAA has raised the demand for randomised controlled trials (RCTs) in order to resolve a potential superiority of either OR or EVAR.

Purpose

This review discusses the current treatment strategies in rAAA repair including diagnostics, peri-operative management and results of OR and EVAR, focussing on RCTs comparing both modalities.

Results

Thirty-day mortality after OR and EVAR shows no significant difference in published RCTs. In particular with respect to OR, 30-day mortality was much lower than anticipated throughout all RCTs ranging from 18 to 37 %. EVAR for rAAA resulted in reduced in-hospital stay. Limitations of all except one RCT are low patient recruitment and exclusion of haemodynamically unstable patients.

Conclusions

OR and EVAR need to be provided for rAAA. Despite lacking evidence, EVAR is the first choice treatment in experienced high-volume vascular centres. Low mortality rates in all RCTs raise the question if aortic surgery should be centralised.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lindholt JS, Sogaard R, Laustsen J (2012) Prognosis of ruptured abdominal aortic aneurysms in Denmark from 1994–2008. Clin Epidemiol 4:111–113

    Article  PubMed  PubMed Central  Google Scholar 

  2. Taylor LM Jr, Porter JM (1987) Basic data related to clinical decision-making in abdominal aortic aneurysms. Ann Vasc Surg 1(4):502–504

    Article  PubMed  Google Scholar 

  3. Bown MJ, Sutton AJ, Bell PR, Sayers RD (2002) A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 89(6):714–730

    Article  CAS  PubMed  Google Scholar 

  4. Hoornweg LL, Storm-Versloot MN, Ubbink DT, Koelemay MJ, Legemate DA, Balm R (2008) Meta analysis on mortality of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 35(5):558–570

    Article  CAS  PubMed  Google Scholar 

  5. Blakemore AH, Voorhees AB (1954) The use of tubes constructed from vinyon “N” cloth in bridging arterial defects—experimental and clinical. Ann Surg 140:324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Yusuf SW, Whitaker SC, Chuter TA, Wenham PW, Hopkinson BR (1994) Emergency endovascular repair of leaking aortic aneurysm. Lancet 344(8937):1645

    Article  CAS  PubMed  Google Scholar 

  7. Marin ML, Veith FJ, Cynamon J, Sanchez LA, Lyon RT, Levine BA, Bakal CW, Suggs WD, Wengerter KR, Rivers SP, et al. (1995) Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions. Ann Surg 222 (4):449–465; discussion 465–449

  8. Egorova N, Giacovelli J, Greco G, Gelijns A, Kent CK, McKinsey JF (2008) National outcomes for the treatment of ruptured abdominal aortic aneurysm: comparison of open versus endovascular repairs. J Vasc Surg 48 (5):1092–1100, 1100 e1091-1092

  9. Holt PJ, Karthikesalingam A, Poloniecki JD, Hinchliffe RJ, Loftus IM, Thompson MM (2010) Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm. Br J Surg 97(4):496–503

    Article  CAS  PubMed  Google Scholar 

  10. Schermerhorn ML, Bensley RP, Giles KA, Hurks R, O’Malley AJ, Cotterill P, Chaikof E, Landon BE (2012) Changes in abdominal aortic aneurysm rupture and short-term mortality, 1995–2008: a retrospective observational study. Ann Surg 256(4):651–658

    Article  PubMed  PubMed Central  Google Scholar 

  11. EVAR trial participants (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365(9478):2179–2186

    Article  Google Scholar 

  12. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, Buskens E, Grobbee DE, Blankensteijn JD (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351(16):1607–1618

    Article  CAS  PubMed  Google Scholar 

  13. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, Lin PH, Jean-Claude JM, Cikrit DF, Swanson KM, Peduzzi PN (2009) Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302(14):1535–1542

    Article  CAS  PubMed  Google Scholar 

  14. Becquemin JP (2009) The ACE trial: a randomized comparison of open versus endovascular repair in good risk patients with abdominal aortic aneurysm. J Vasc Surg 50 (1):222–224; discussion 224

  15. Reimerink JJ, Hoornweg LL, Vahl AC, Wisselink W, van den Broek TA, Legemate DA, Reekers JA, Balm R (2013) Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomized controlled trial. Ann Surg 258(2):248–256

    Article  PubMed  Google Scholar 

  16. Powell JT, Sweeting MJ, Thompson MM, Ashleigh R, Bell R, Gomes M, Greenhalgh RM, Grieve R, Heatley F, Hinchliffe RJ, Thompson SG, Ulug P (2014) Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 348:f7661

    Article  PubMed  Google Scholar 

  17. Desgranges P, Kobeiter H, Katsahian S, Bouffi M, Gouny P, Favre JP, Alsac JM, Sobocinski J, Julia P, Alimi Y, Steinmetz E, Haulon S, Alric P, Canaud L, Castier Y, Jean-Baptiste E, Hassen-Khodja R, Lermusiaux P, Feugier P, Destrieux-Garnier L, Charles-Nelson A, Marzelle J, Majewski M, Bourmaud A, Becquemin JP (2015) ECAR (Endovasculaire ou Chirurgie dans les Anevrysmes aorto-iliaques Rompus): a French randomized controlled trial of endovascular versus open surgical repair of ruptured aorto-iliac aneurysms. Eur J Vasc Endovasc Surg 50(3):303–310

  18. Karthikesalingam A, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJ (2010) Volume-outcome relationships in vascular surgery: the current status. J Endovasc Ther 17(3):356–365

    Article  PubMed  Google Scholar 

  19. Laukontaus SJ, Aho PS, Pettila V, Alback A, Kantonen I, Railo M, Hynninen M, Lepantalo M (2007) Decrease of mortality of ruptured abdominal aortic aneurysm after centralization and in-hospital quality improvement of vascular service. Ann Vasc Surg 21(5):580–585

    Article  PubMed  Google Scholar 

  20. Van Herzeele I, Sevdalis N, Lachat M, Desender L, Rudarakanchana N, Rancic Z (2014) Team training in ruptured EVAR. J Cardiovasc Surg (Torino) 55(2):193–206

    Google Scholar 

  21. Catalano O, Siani A (2005) Ruptured abdominal aortic aneurysm: categorization of sonographic findings and report of 3 new signs. J Ultrasound Med 24(8):1077–1083

    PubMed  Google Scholar 

  22. Dutton RP, Mackenzie CF, Scalea TM (2002) Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma 52(6):1141–1146

    Article  PubMed  Google Scholar 

  23. Kreimeier U, Messmer K (2002) Small-volume resuscitation with hypertonic sodium colloid solution—what does clinical routine tell us? Wien Klin Wochenschr 114(3):76–77

    CAS  PubMed  Google Scholar 

  24. Mapstone J, Roberts I, Evans P (2003) Fluid resuscitation strategies: a systematic review of animal trials. J Trauma 55(3):571–589

    Article  PubMed  Google Scholar 

  25. Kentner R, Safar P, Prueckner S, Behringer W, Wu X, Henchir J, Ruemelin A, Tisherman SA (2005) Titrated hypertonic/hyperoncotic solution for hypotensive fluid resuscitation during uncontrolled hemorrhagic shock in rats. Resuscitation 65(1):87–95

    Article  PubMed  Google Scholar 

  26. Johansson PI, Stensballe J (2010) Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets—a review of the current literature. Transfusion 50(3):701–710

    Article  PubMed  Google Scholar 

  27. Gawenda M, Brunkwall J (2012) Ruptured abdominal aortic aneurysm: the state of play. Dtsch Arztebl Int 109(43):727–732

    PubMed  PubMed Central  Google Scholar 

  28. Lloyd GM, Bown MJ, Norwood MG, Deb R, Fishwick G, Bell PR, Sayers RD (2004) Feasibility of preoperative computer tomography in patients with ruptured abdominal aortic aneurysm: a time-to-death study in patients without operation. J Vasc Surg 39(4):788–791

    Article  CAS  PubMed  Google Scholar 

  29. Mehta M, Kreienberg PB, Roddy SP, Paty PS, Taggert JB, Sternbach Y, Hnath J, Ozsvath KJ, Chang BB, Shah DM, Darling RC 3rd (2010) Ruptured abdominal aortic aneurysm: endovascular program development and results. Semin Vasc Surg 23(4):206–214

    Article  PubMed  Google Scholar 

  30. Knapp J, Bernhard M, Rauch H, Hyhlik-Durr A, Bockler D, Walther A (2009) Anesthesiologic procedure for elective aortic surgery. Anaesthesist 58(11):1161–1182

    Article  CAS  PubMed  Google Scholar 

  31. Powell JT, Hinchliffe RJ, Thompson MM, Sweeting MJ, Ashleigh R, Bell R, Gomes M, Greenhalgh RM, Grieve RJ, Heatley F, Thompson SG, Ulug P (2014) Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg 101 (3):216–224; discussion 224

  32. Arthurs Z, Starnes B, See C, Andersen C (2006) Clamp before you cut: proximal control of ruptured abdominal aortic aneurysms using endovascular balloon occlusion—case reports. Vasc Endovascular Surg 40(2):149–155

    Article  PubMed  Google Scholar 

  33. Eslami MH, Messina LM (2010) Ruptured AAA: open surgical management. Semin Vasc Surg 23(4):200–205

    Article  PubMed  Google Scholar 

  34. Kauvar DS, Sarfati MR, Kraiss LW (2012) Intraoperative blood product resuscitation and mortality in ruptured abdominal aortic aneurysm. J Vasc Surg 55(3):688–692

    Article  PubMed  Google Scholar 

  35. Mell MW, O’Neil AS, Callcut RA, Acher CW, Hoch JR, Tefera G, Turnipseed WD (2010) Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Surgery 148(5):955–962

    Article  PubMed  Google Scholar 

  36. van Herwaarden JA, van Vroonhoven TJ (2001) Abdominal packing for surgically uncontrollable hemorrhage in ruptured abdominal aortic aneurysm repair. J Vasc Surg 33(1):195–196

    Article  PubMed  Google Scholar 

  37. Magee TR, Scott DJ, Dunkley A, St Johnston J, Campbell WB, Baird RN, Horrocks M (1992) Quality of life following surgery for abdominal aortic aneurysm. Br J Surg 79(10):1014–1016

    Article  CAS  PubMed  Google Scholar 

  38. Harris LM, Faggioli GL, Fiedler R, Curl GR, Ricotta JJ (1991) Ruptured abdominal aortic aneurysms: factors affecting mortality rates. J Vasc Surg 14 (6):812–818; discussion 819–820

  39. Brandt CP, Piotrowski JJ, Alexander JJ (1997) Flexible sigmoidoscopy. A reliable determinant of colonic ischemia following ruptured abdominal aortic aneurysm. Surg Endosc 11(2):113–115

    Article  CAS  PubMed  Google Scholar 

  40. Mayer D, Rancic Z, Meier C, Pfammatter T, Veith FJ, Lachat M (2009) Open abdomen treatment following endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 50(1):1–7

    Article  PubMed  Google Scholar 

  41. Djavani Gidlund K, Wanhainen A, Bjorck M (2011) Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 41(6):742–747

    Article  CAS  PubMed  Google Scholar 

  42. Djavani K, Wanhainen A, Bjorck M (2006) Intra-abdominal hypertension and abdominal compartment syndrome following surgery for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 31(6):581–584

    Article  CAS  PubMed  Google Scholar 

  43. Rasmussen TE, Hallett JW Jr, Noel AA, Jenkins G, Bower TC, Cherry KJ Jr, Panneton JM, Gloviczki P (2002) Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study. J Vasc Surg 35(2):246–253

    Article  PubMed  Google Scholar 

  44. McPhee J, Eslami MH, Arous EJ, Messina LM, Schanzer A (2009) 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 Vasc Surg 49(4):817–826

    Article  PubMed  Google Scholar 

  45. Cambria RP, Brewster DC, Abbott WM, Freehan M, Megerman J, LaMuraglia G, Wilson R, Wilson D, Teplick R, Davison JK (1990) Transperitoneal versus retroperitoneal approach for aortic reconstruction: a randomized prospective study. J Vasc Surg 11 (2):314–324; discussion 324–315

  46. Ockert S, Böckler D, Allenberg J, Schumacher H (2007) Ruptured abdominal aortic aneurysm: treatment strategy and point of procedure. Gefässchirurgie 12:379–391

    Article  Google Scholar 

  47. Grotemeyer D, Strauss K, Weis-Muller BT, Drabik A, Sandmann W (2008) Ruptured abdominal aortic aneurysm: perioperative indicators for the clinical course following conventional open surgery. Chirurg 79(8):745–752

    Article  CAS  PubMed  Google Scholar 

  48. van der Vliet JA, van Aalst DL, Schultze Kool LJ, Wever JJ, Blankensteijn JD (2007) Hypotensive hemostatis (permissive hypotension) for ruptured abdominal aortic aneurysm: are we really in control? Vascular 15(4):197–200

    Article  PubMed  Google Scholar 

  49. Noel AA, Gloviczki P, Cherry KJ Jr, Bower TC, Panneton JM, Mozes GI, Harmsen WS, Jenkins GD, Hallett JW Jr (2001) Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair. J Vasc Surg 34(1):41–46

    Article  CAS  PubMed  Google Scholar 

  50. Biancari F, Mazziotti MA, Paone R, Laukontaus S, Venermo M, Lepantalo M (2011) Outcome after open repair of ruptured abdominal aortic aneurysm in patients >80 years old: a systematic review and meta-analysis. World J Surg 35(7):1662–1670

    Article  PubMed  Google Scholar 

  51. Mani K, Bjorck M, Lundkvist J, Wanhainen A (2009) Improved long-term survival after abdominal aortic aneurysm repair. Circulation 120(3):201–211

    Article  PubMed  Google Scholar 

  52. Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM (2014) Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev 1, CD004178

    PubMed  Google Scholar 

  53. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362(20):1863–1871

    Article  PubMed  Google Scholar 

  54. von Allmen RS, Schmidli J, Dick F (2013) Regarding “endovascular vs open repair for ruptured abdominal aortic aneurysm”. J Vasc Surg 57(3):897

    Article  Google Scholar 

  55. Saqib N, Park SC, Park T, Rhee RY, Chaer RA, Makaroun MS, Cho JS (2012) Endovascular repair of ruptured abdominal aortic aneurysm does not confer survival benefits over open repair. J Vasc Surg 56(3):614–619

    Article  PubMed  Google Scholar 

  56. Veith FJ, Lachat M, Mayer D, Malina M, Holst J, Mehta M, Verhoeven EL, Larzon T, Gennai S, Coppi G, Lipsitz EC, Gargiulo NJ, van der Vliet JA, Blankensteijn J, Buth J, Lee WA, Biasi G, Deleo G, Kasirajan K, Moore R, Soong CV, Cayne NS, Farber MA, Raithel D, Greenberg RK, van Sambeek MR, Brunkwall JS, Rockman CB, Hinchliffe RJ (2009) Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann Surg 250(5):818–824

    Article  PubMed  Google Scholar 

  57. Mayer D, Aeschbacher S, Pfammatter T, Veith FJ, Norgren L, Magnuson A, Rancic Z, Lachat M, Horer T, Skoog P, Larzon T (2012) Complete replacement of open repair for ruptured abdominal aortic aneurysms by endovascular aneurysm repair: a two-center 14-year experience. Ann Surg 256 (5):688–695; discussion 695–686

  58. Schanzer A, Greenberg RK, Hevelone N, Robinson WP, Eslami MH, Goldberg RJ, Messina L (2011) Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation 123(24):2848–2855

    Article  PubMed  Google Scholar 

  59. Peppelenbosch N, Geelkerken RH, Soong C, Cao P, Steinmetz OK, Teijink JA, Lepantalo M, De Letter J, Vermassen FE, DeRose G, Buskens E, Buth J (2006) Endograft treatment of ruptured abdominal aortic aneurysms using the Talent aortouniiliac system: an international multicenter study. J Vasc Surg 43 (6):1111–1123; discussion 1123

  60. Hinchliffe RJ, Braithwaite BD (2007) A modular aortouniiliac endovascular stent-graft is a useful device for the treatment of symptomatic and ruptured infrarenal abdominal aortic aneurysms: one-year results from a multicentre study. Eur J Vasc Endovasc Surg 34(3):291–298

    Article  CAS  PubMed  Google Scholar 

  61. Donayre CE, Zarins CK, Krievins DK, Holden A, Hill A, Calderas C, Velez J, White RA (2011) Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair. J Vasc Surg 53(3):574–582

    Article  PubMed  Google Scholar 

  62. de Bruin JL, Brownrigg JR, Karthikesalingam A, Patterson BO, Holt PJ, Hinchliffe RJ, Morgan RA, Loftus IM, Thompson MM (2015) Endovascular aneurysm sealing for the treatment of ruptured abdominal aortic aneurysms. J Endovasc Ther 22(3):283–287

    Article  PubMed  PubMed Central  Google Scholar 

  63. Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA (2012) Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 53 (4):895–904; discussion 904–895

  64. Bisdas T, Donas KP, Bosiers M, Torsello G, Austermann M (2013) One-year follow-up after total endovascular repair of a contained-ruptured thoracoabdominal aortic aneurysm with the sandwich technique. J Vasc Surg 58(2):482–485

    Article  PubMed  Google Scholar 

  65. Edwards ST, Schermerhorn ML, O’Malley AJ, Bensley RP, Hurks R, Cotterill P, Landon BE (2014) Comparative effectiveness of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Medicare population. J Vasc Surg 59(3):575–582

    Article  PubMed  PubMed Central  Google Scholar 

  66. van Beek SC, Vahl A, Wisselink W, Reekers JA, Legemate DA, Balm R (2015) Midterm re-interventions and survival after endovascular versus open repair for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 49(6):661–668

    Article  PubMed  Google Scholar 

  67. Hinchliffe RJ, Bruijstens L, MacSweeney ST, Braithwaite BD (2006) A randomised trial of endovascular and open surgery for ruptured abdominal aortic aneurysm—results of a pilot study and lessons learned for future studies. Eur J Vasc Endovasc Surg 32 (5):506–513; discussion 514–505

  68. McHugh SM, Aherne T, Goetz T, Byrne J, Boyle E, Allen M, Leahy A, Moneley D, Naughton P (2015) Endovascular versus open repair of ruptured abdominal aortic aneurysm. Surgeon

  69. Antoniou GA, Georgiadis GS, Antoniou SA, Pavlidis P, Maras D, Sfyroeras GS, Georgakarakos EI, Lazarides MK (2013) Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair. J Vasc Surg 58(4):1091–1105

    Article  PubMed  Google Scholar 

  70. Mohan PP, Hamblin MH (2014) Comparison of endovascular and open repair of ruptured abdominal aortic aneurysm in the United States in the past decade. Cardiovasc Intervent Radiol 37(2):337–342

    Article  PubMed  Google Scholar 

  71. Giles KA, Hamdan AD, Pomposelli FB, Wyers MC, Dahlberg SE, Schermerhorn ML (2009) Population-based outcomes following endovascular and open repair of ruptured abdominal aortic aneurysms. J Endovasc Ther 16(5):554–564

    Article  PubMed  PubMed Central  Google Scholar 

  72. Ali MM, Flahive J, Schanzer A, Simons JP, Aiello FA, Doucet DR, Messina LM, Robinson WP (2015) In patients stratified by preoperative risk, endovascular repair of ruptured abdominal aortic aneurysms has a lower in-hospital mortality and morbidity than open repair. J Vasc Surg 61(6):1399–1407

    Article  PubMed  Google Scholar 

  73. Veith FJ, Rockman CB (2015) The recent randomized trials of EVAR versus open repair for ruptured abdominal aortic aneurysms are misleading. Vascular 23(2):217–219

    Article  PubMed  Google Scholar 

  74. IMPROVE Trial Investigators (2015) The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm. Eur Heart J 36(21):1328–1334

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Andreas S. Peters, Maani Hakimi, Philipp Erhart, Markus Wortmann, Moritz S. Bischoff & Dittmar Böckler

  2. Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany

    Michael Keese & Thomas Schmitz-Rixen

Authors
  1. Andreas S. Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maani Hakimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Erhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Keese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Schmitz-Rixen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Markus Wortmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Moritz S. Bischoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dittmar Böckler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dittmar Böckler.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peters, A.S., Hakimi, M., Erhart, P. et al. Current treatment strategies for ruptured abdominal aortic aneurysm. Langenbecks Arch Surg 401, 289–298 (2016). https://doi.org/10.1007/s00423-016-1405-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1405-4

Keywords

Search

Navigation