Ruptured abdominal aortic aneurysms: Factors affecting mortality rates

Abstract

Outcome of 113 operations for ruptured abdominal aortic aneurysms were reviewed to determine the contribution of perioperative events to mortality rates. Preoperative, intraoperative, and postoperative factors were examined with regard to their influence on early and late deaths. A mortality rate of 64% (72/113) was unrelated to age, gender, and preexistent medical conditions. Death within 48 hours occurred in 42 of 72 patients (58%). Preoperative status, including cardiac arrest, loss of consciousness, and acidosis influenced early deaths (less than 48 hours) but not late deaths. Early deaths were also influenced by severe operative hypotension and excessive transfusion requirements. Late deaths (greater than 48 hours) occurred in 30/72 cases (42%) at a mean of 24.6 +/- 22.9 days. Late death was related to postoperative organ system failure, specifically renal and respiratory failure, and the need for reoperation. The overall mortality rate was influenced by preoperative, intraoperative, and postoperative factors. Postoperative renal failure was the strongest predictor of overall deaths. Survival after ruptured abdominal aortic aneurysm depends on intraoperative and postoperative complications as well as preoperative conditions. Late death, the greatest strain on resources, is independent of preoperative status. The thesis that some patients with ruptured abdominal aortic aneurysm should be denied operation to conserve resources is not supported by these data. Efforts to improve survival should focus on reducing intraoperative complications and improving management of postoperative organ failure.

Ruptured Abdominal Aortic Aneurysms

“…Although the surgical mortality rate for elective AAA repair has steadily improved due to advancements in operative techniques and perioperative care and has fallen to less than 2% in specialized centres and 5% in lessspecialized hospitals, the mortality rate of RAAA has not significantly changed over the past three decades and still ranges between 30 and 70% according to recent reports (Heller et al, 2000;Marty-Ane et al, 1995;Mureebe et al, 2008;Cho et al, 2008;Darling et al, 1996). The high mortality seems to be related to a combination of hemorrhagic shock and lower torso ischaemia followed by reperfusion injury despite successful revascularization (Harris et al, 1991;Bown et al, 2002) Given the poor outcomes after open RAAA repair and in the light of lower perioperative morbidity and mortality after EVAR, some centers have adopted EVAR protocols for RAAA repair. Excellent results have been reported by those centers where the mortality rate has fallen to as low as 30% (Ten Bosch et al, 2010;Visser et al, 2007).…”

“…Of patients with renal failure, 11-40% require postoperative dialysis with an associated mortality rate of 76-89% (Harris et al, 1991;Magee et al, 1992). Impairment in renal function has been associated with suprarenal cross-clamping, duration of cross clamping >30 minutes, preexisting conditions of renal dysfunction (serum creatinine > 2 mg/dl), shock, and age over 80 (Bonventre 2007;Nicholson et al, 1996).…”

Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011)

“…[193][194][195] Circulatory failure may cause the complications of multiple organ failure, respiratory failure, renal failure, and colonic ischemia. 196,197 peutic results have been obtained owing to arch replacement using improved adjuvant measures and the recent introduction of fibrin glue and stent-grafts. 46,157-161 The in-hospital mortality rate of acute type A dissection surgery has recently improved to about 10% in Japan.…”

Standard and New Treatments for Abdominal Aortic Aneurysms

“…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.…”