Who Should Be Operated When Presenting with a Ruptured Abdominal Aortic Aneurysm? A Monocentric Study in a Tertiary...

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Clinical Decision-Making

Background:

• Ruptured abdominal aortic aneurysms (rAAA) have high mortality rates, with surgery offering a survival chance.
• Differentiating between patients who should undergo surgery versus palliative care in emergencies is challenging.
• This study aimed to identify critical factors for guiding treatment decisions in rAAA patients.

Purpose of the Study:

• To identify preoperative and perioperative factors associated with in-hospital mortality in patients with ruptured abdominal aortic aneurysms.
• To evaluate the role of institutionalization and long-term mortality in the decision-making process for rAAA treatment.

Main Methods:

• Retrospective single-center study of 72 patients with rAAA treated between 2001 and 2014.
• Exclusion of symptomatic aneurysms and isolated ruptured iliac aneurysms.
• Univariate logistic regression analysis to assess associations between predictive factors and in-hospital mortality.

Main Results:

• Overall in-hospital mortality was 21% for treated rAAA patients.
• Increased age and female sex were significant preoperative risk factors for mortality.
• Suprarenal clamping, blood product transfusion volume, and number of transfusions were significant perioperative risk factors.

Conclusions:

• Age and female sex are the most significant preoperative predictors of mortality in ruptured abdominal aortic aneurysms.
• Institutionalization rates and long-term mortality should not be primary considerations in the acute decision-making process for rAAA.