Ruptured abdominal aortic aneurysm: The Harborview experience

Abstract

During the last decade (1980 to 1989) 186 patients with ruptured abdominal aortic aneurysm were admitted to a single urban hospital. Ninety-six percent of these patients had a prehospital systolic blood pressure less than 90 mm Hg. Management included paramedic field resuscitation and transport, an emergency department diagnostic protocol completed in an average of 12 minutes, rapid transport to a dedicated emergency operating room, aneurysmorrhaphy by general surgery chief residents under the supervision of specialist vascular surgeons, and skilled postoperative intensive care unit care. Nevertheless, 130 (70%) patients died in the first 30 postoperative days--3% in the emergency department, 13% in the operating room, 51% in the intensive care unit, and 3% on the ward or at home. Certain features--age greater than 80 years, female gender, persistent preoperative hypotension despite aggressive crystalloid and blood replacement, admission hematocrit less than 25, transfusion requirements exceeding 15 units--were associated with a greater than 90% likelihood of death. No patient with preoperative cardiac arrest survived more than 24 hours. From this experience we conclude that, although "optimal" prehospital, emergency department, operating room, and postoperative care can improve the outcome of patients with ruptured abdominal aortic aneurysms in shock, most such patients will die. Certain clinical features predict such excessive mortality rates after ruptured abdominal aortic aneurysms that withholding operation may be reasonable. Screening of patients at high risk for abdominal aortic aneurysm, followed by elective aneurysmorrhaphy, is clearly indicated.

Prognostic indicators following emergency aortic aneurysm repair

“…All of the commonly used severity of illness scores for critically ill patients include a weight for advancing age. Advancing age is known to be associated with an increase in mortality following emergency repair of abdominal aortic aneurysms [1,3,5,7,13]. Our study confirms that age is an independent predictor for death before 100 days.…”

“…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.…”

“…If the patients recover from their emergency aneurysm repair, longer term survival appears good [5,11]. Therefore, the emphasis is on operating on the majority of patients who present.…”

“…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.…”

Morphological aspects of mural thrombi deposition residual lumen route in infrarenal abdominal aorta aneurisms

“…AAA causes 15,000 deaths per year in the United States, and its incidence does not decrease over time. [4][5][6][7][8][9] An intraluminal thrombus (ILT) is present in approximately 75% of all cases of AAA. 10 Recent studies suggest that the ILT is an active pathogenic factor for AAA.…”