Improved survival after ruptured abdominal aortic aneurysm

Rupture of an abdominal aortic aneurysm continues to be the most imminently catastrophic situation facing the peripheral vascular surgeon. Without emergency resection the mortality is 100%, and in the past, even with operation, few patients have survived. Numerous recent reports continue to show mortality rates exceeding 50%. Our survival rates have been significantly improved by an aggressive, preplanned approach to all patients with abdominal pain and aneurysms. Mortality rates have improved from 69% for 22 patients operated on between 1962 and 1970 to 23% for 35 patients operated on from 1971 to 1978. Successful management requires coordinated effort by the blood bank, emergency room, and operating room facilities, as well as rapid and definitive operative technic to control and replace the aneurysm. Compression of the aorta at the diaphragm, systemic heparinization, and limiting the resection to the aorta whenever possible have proved useful.