Risk factors affecting survival after surgical repair of ruptured abdominal aortic aneurysm

[Ruptured aneurysms of the infrarenal abdominal aorta: surgical aspects in Dakar about 6 observations]

La rupture des anévrismes de l'aorte est une situation catastrophique. La chirurgie ouverte et le traitement endovasculaire sont débattus comme option. Dans cette étude sont évaluées les modalités du traitement chirurgical et ses résultats sur 6 malades opérés pour rupture d'un anévrysme de l'aorte abdominale sous-rénale. Dans 4 cas, il s'agissait d'une « rupture contenue » dans le péritoine pariétal postérieur, avec un hématome péri vertébral. Dans les 2 autres cas, il s'agissait d'une rupture en péritoine libre. Tous les malades avaient bénéficié après contrôle de l'hémostase d'une mise à plat de l'anévrisme suivie de greffe d'une prothèse aortique. Des complications précoces étaient notées chez 2 patients à type d'insuffisance rénale aigue et de poussée hypertensive. La mortalité opératoire était de 16,66%. La morbi-motalité des anévrismes rompus de l'aorte abdominale est particulièrement élevée, d'où la nécessité d'un dépistage précoce des patients à risque et l'introduction de la chirurgie endovasculaire.

Risk Factors for Survival following Open Surgical Repair of Ruptured Abdominal Aortic Aneurysms: A 13-Year Experience

BACKGROUND

Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA.

METHODS

Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality.

RESULTS

One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively).

CONCLUSION

This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs.