Authors: Philip Dueppers MD, Markus U. Wagenhäuser MD, Ali M. Irga, Mansur Duran MD.
Background: A ruptured abdominal aortic aneurysm (rAAA) is life-threatening. The mortality is high and emergency surgery is vital. Endovascular (ER) and open surgical repair (OR) are alternative approaches. Although ER is considered as first-line treatment, there are scenarios which still require OR. We report a single-centre experience for rAAA treated by OR.
Methods: Medical records from patients with rAAA from 1 January 2005 through 31 December 2016 were screened. We defined rAAA as retro- or intraperitoneal haemorrhage originating from the infra- or juxtarenal aorta. We analysed the surgical approaches and report patient short-term and follow-up outcomes. Statistical differences were examined by log rank and chi-square test.
Results: Thirty-five patients at the mean age of 73 ± 10 years (47–91) were included. Aneurysm location was infrarenal (n = 20), juxtarenal (n = 8), and involved the iliac arteries (n = 7). OR was performed by tube (n = 26) or bifurcation graft (n = 9) implantation. Additional vascular reconstructions were performed in 14 patients. We observed one intra-operative oesophageal leakage. Post-operative complications included haemodialysis (n = 17), tracheotomy (n = 15), multiple organ failure (n = 11), cardiopulmonary resuscitation (n = 5), intestinal ischaemia (n = 5), sepsis (n = 5), stroke (n = 3) and coronary stenting (n = 2). Nine patients required early revision surgery. There were twelve patients available for the follow-up. Thirty-day mortality was 37%, and overall mortality was 40% after 118 months. Mortality was associated with the direction of rupture, the shock index (SI) and the need for early revision surgery (p = <0.05).
Conclusion: OR for rAAA remains valuable. In cases for which OR is warranted, the direction of rupture, SI and need for early revision surgery were predictors for mortality.
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