Twenty-one years' experience with ruptured abdominal aortic aneurysms

Area of Science:

• Vascular Surgery
• Surgical Outcomes

Background:

• Ruptured abdominal aortic aneurysms (rAAA) historically carried a high mortality rate.
• Diagnosis of rAAA can be challenging, often presenting with non-specific pain symptoms.
• Early surgical intervention for abdominal aortic aneurysms (AAAs) is crucial.

Purpose of the Study:

• To review the surgical experience with ruptured abdominal aortic aneurysms (rAAA) over a 23-year period.
• To identify factors contributing to improved outcomes in rAAA management.
• To advocate for elective aneurysm resection to reduce rupture-related mortality.

Main Methods:

• Retrospective review of 107 cases of ruptured abdominal aortic aneurysms (rAAA) treated surgically between 1953 and 1975.
• Analysis of operative mortality rates and contributing factors.
• Comparison with outcomes of elective abdominal aortic aneurysm (AAA) resection.

Main Results:

• Operative mortality for rAAA decreased from 86% in the earlier period to 40% after 1966.
• Improvements in blood loss control and reduced aortic cross-clamping time were key factors.
• Intra-aortic balloon use was beneficial.
• 24 patients died pre-operatively from rAAA, with only 7 correctly diagnosed prior to death.
• Elective abdominal aortic aneurysm (AAA) resection had <1% operative mortality in the last 8 years of the study.

Conclusions:

• Advances in surgical techniques have substantially improved survival rates for ruptured abdominal aortic aneurysms (rAAA).
• Early diagnosis and prompt elective resection of abdominal aortic aneurysms (AAAs) are essential to avoid the high mortality associated with rupture.
• Alertness to the varied presentation of rAAA is critical for timely diagnosis and intervention.