Treatment strategy for ruptured abdominal aortic aneurysms.

Area of Science:

• Vascular Surgery
• Aortic Aneurysm Research
• Public Health

Background:

• Ruptured abdominal aortic aneurysms (AAA) remain a highly lethal complication, with mortality rates reaching 90%, often due to pre-hospital deaths.
• The incidence of degenerative AAA is increasing, linked to an aging global population.
• Despite advancements, ruptured AAA management presents significant challenges, necessitating optimized therapeutic approaches.

Purpose of the Study:

• To analyze current literature and clinical experience regarding ruptured abdominal aortic aneurysm (AAA) management.
• To present viable vascular medicine options for resource-limited settings lacking advanced endovascular capabilities.
• To emphasize the importance of tailored treatment strategies and surgical expertise in improving outcomes.

Main Methods:

• Literature analysis, including current guidelines and extensive clinical experience.
• Case studies and discussion of treatment options for ruptured abdominal aortic aneurysms (AAA).
• Evaluation of endovascular aneurysm repair (EVAR) suitability and the role of open surgical repair.

Main Results:

• Thirty-day mortality for ruptured AAA repair is significantly lower in high-volume hospitals.
• Not all ruptured AAA cases are suitable for EVAR; open repair by experienced surgeons is vital.
• Open surgical conversion is sometimes necessary for endovascular complications.

Conclusions:

• There is no single ideal procedure for AAA; each approach has unique benefits and drawbacks.
• Future reductions in ruptured AAA mortality depend on screening, preventing organ injury, and technological advancements.
• Comprehensive training for vascular surgeons in both open and endovascular aortic surgery is essential.