The "stable" ruptured abdominal aortic aneurysm gives a false sense of security.
BACKGROUND
Operative mortality for ruptured abdominal aortic aneurysms (rAAA) has not changed over the past 4 decades. Previous studies have attempted to identify preoperative risk factors that impact upon survival.


METHODS
A retrospective review of 25 patients with rAAA treated during a 2-year period was performed. Patients were divided into groups based upon the presence (GpI), absence (GpIIa), or subsequent development of preoperative hypotension (GpIIb). Time intervals from initial presentation to arrival in the operating room (IP-OR), to cross clamp application (IP-XC), and from observed hypotension to cross clamp (HYPO-XC) were recorded.


RESULTS
Average time intervals for IP-OR and IP-XC were significantly shorter for GpI compared with GpIIa and GpIIb. No difference in HYPO-XC was noted between GpI and GpIIb. Mortality was 33% for GpI, 25% for GpIIa, and 87.5% for GpIIb.


CONCLUSIONS
Normal admission blood pressure led to a decreased sense of urgency, creating avoidable delays and missed opportunities for salvage.
Weinstein
E S
ES
Columbia Swedish Medical Center, Englewood, Colorado, USA.
Cooper
M
M
Hammond
S
S
Carlson
R
R
Guber
M
M
Maloy
J
J
D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome