Factors determining survival after ruptured aortic aneurysm: The hospital, the surgeon, and the patient

Ouriel, Kenneth; Geary, Kevin; Green, Richard M.; Fiore, William M.; Geary, Joseph E.; DeWeese, James A.

doi:10.1016/0741-5214(90)90292-i

Cited by 136 publications

(30 citation statements)

References 5 publications

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“…The present study shows that intra-operative hypotension is associated with an increase in peri-operative and longer term mortality. The surgeon's experience affects the outcome in some series [6,7], and it has been suggested that the outcome of abdominal aortic aneurysm repair is better in large regional centres [6,12]. The present study is too small to confirm or refute these advantages in the district hospital setting.…”

Section: Discussioncontrasting

confidence: 44%

“…All patients with the diagnosis of abdominal aortic aneurysm who reached the operating theatre alive were studied. A literature search was performed and papers containing information on the survival of patients who had undergone abdominal aortic aneurysm repair were reviewed [1][2][3][4][5][6]. Factors which may be linked with prognosis were identified.…”

Section: Methodsmentioning

confidence: 99%

“…As these patients have poor physiological reserve, morbidity is high and survival poor. Reported mortality figures following emergency repair vary between 30 and 70% [1][2][3][4][5][6], while those for elective repair are lower at 1.4-6% [1,7,8]. Furthermore, abdominal aortic aneurysms are common, with an incidence of 17-64 per 100 000 of the population in the UK [9,10], and so emergency repair of abdominal aortic aneurysm represents a significant workload for vascular surgery and critical care services.…”

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confidence: 99%

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Prognostic indicators following emergency aortic aneurysm repair

Urwin¹,

Ridley²

1999

Anaesthesia

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SummaryWe performed a retrospective study of 135 patients presenting for emergency abdominal aneurysm repair to determine predictive factors for outcome. The outcome measures investigated were mortality in the operating theatre and intensive care, and at 28 and 100 days. Univariate analysis showed that the patient's age, hypotension on admission, aneurysmal rupture, pre-operative cardiopulmonary resuscitation, intra-operative blood loss and hypotension were risk factors for death either in the operating theatre or up to 100 days after surgery. Binary logistic regression identified the independent risk factors for survival. Operative survival was determined by acute factors such as pre-operative cardiopulmonary resuscitation, aneurysmal rupture and intra-operative hypotension. Longer term survival was determined by the patient's age, aneurysmal rupture, blood loss and blood pressure at admission. Using a binary logistic regression equation, from which a simplified risk score was derived, it is possible to predict the likelihood of survival of individual patients presenting for abdominal aortic aneurysm repair.

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Section: Discussioncontrasting

confidence: 44%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Prognostic indicators following emergency aortic aneurysm repair

Urwin¹,

Ridley²

1999

Anaesthesia

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“…As a result, most of the recent literature on ruptured AAAs has focused on selecting patients who are likely to survive, and some authors have advocated abandoning treatment for certain groups of patients who have risk factors that predict a poor outcome. 5,6,8,9,11,15,16,19,20,22 In addition, it has been thought that further improvement in surgical outcome is unlikely; therefore, the focus has shifted toward screening patients to treat aneurysms before they rupture. 3,8,12,18 -20 We believe the reason why the outcome after surgical repair of ruptured aortoiliac aneurysms (AIAs) has not improved relates to the fact that the basic surgical techniques for repairing ruptured AIAs remain little changed in the past four decades, although several improvements have been introduced.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Grafts and Other Image-Guided Catheter-Based Adjuncts to Improve the Treatment of Ruptured Aortoiliac Aneurysms

Ohki¹,

Veith²

2000

Annals of Surgery

171

142

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ObjectiveTo report a new management approach for the treatment of ruptured aortoiliac aneurysms. MethodsThis approach includes hypotensive hemostasis, minimizing fluid resuscitation, and allowing the systolic blood pressure to fall to 50 mmHg. Under local anesthesia, a transbrachial guidewire was placed under fluoroscopic control in the supraceliac aorta. A 40-mm balloon catheter was inserted over this guidewire and inflated only if the blood pressure was less than 50 mmHg, before or after the induction of anesthesia. Fluoroscopic angiography was used to determine the suitability for endovascular graft repair. When possible, a prepared, "one-size-fits-most" endovascular aortounifemoral stented PTFE graft was used, combined with occlusion of the contralateral common iliac artery and femorofemoral bypass. If the patient's anatomy was unsuitable for endovascular graft repair, standard open repair was performed using proximal balloon control as needed. ResultsTwenty-five patients with ruptured aortoiliac aneurysms (18 aortic, 7 iliac) were managed using this approach. Balloon inflation for proximal control was required in nine of the 25 patients. Twenty patients were treated with endovascular grafts. Five patients required open repair. The ruptured aneurysm was excluded in all 25 patients; 23 survived. Two deaths occurred in patients who received endovascular grafts with serious comorbidities. The surviving patients who received endovascular grafts had a median hospital stay of 6 days, and the preoperative symptoms resolved in all patients. ConclusionsHypotensive hemostasis is usually an effective means to provide time for balloon placement and often for endovascular graft insertion. With appropriate preparation and planning, many if not most patients with ruptured aneurysms can be treated by endovascular grafts. Proximal balloon control is not required often but may, when needed, be an invaluable adjunct to both endovascular graft and open repairs. The use of endovascular grafts and this approach using other imageguided catheter-based adjuncts appear to improve treatment outcomes for patients with ruptured aortoiliac aneurysms.Four decades have passed since the first surgical repair of a ruptured infrarenal abdominal aortic aneurysm (AAA) was reported by Gerbode in 1954.1 During this period, several important advances have been made in the nonsurgical aspects of care. These include improvements in the transportation of these patients, critical care, and management of cardiac dysfunction and pharmacologic support. Despite these efforts, surgical death rates have not improved significantly and still range from 24% to 70%. As a result, most of the recent literature on ruptured AAAs has focused on selecting patients who are likely to survive, and some authors have advocated abandoning treatment for certain groups of patients who have risk factors that predict a poor outcome.

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“…These iatrogenic injuries have been the cause of significant operative mortality and morbidity following standard surgery for ruptured aneurysms. [41][42][43][44][45][46] In contrast, EVG repair is performed within the arterial tree, which is unaffected by the extravasated blood or previous operations (scar). Moreover, this approach completely eliminates the risk of inadvertent injuries to surrounding structures.…”

Section: Discussionmentioning

confidence: 99%