Personal experience of the treatment of ruptured aortic aneurysms. The prognostic evaluation of some parameters.
BACKGROUND
The rupture of an aortic aneurysm is the most frequent and most severe complication, with an incidence of approximately 20-40/100,000 persons each year. The aim of this study was to identify the preoperative, intraoperative and postoperative factors that may influence the mortality rate.


METHODS
Between January 1996 and December 1999 145 patients underwent emergency abdominal aortic repair surgery. One hundred and twenty-three patients represented a ruptured AAA and 22 a fissured aneurysm. One hundred and thirty-one patients were males and 14 were females; their mean age was 75+/-5.06 years. We selected a number of parameters after a review of the international literature and these were analysed in the two classes of survivors. No statistical analyses were performed on fissured aneurysms owing to the scant number of cases examined.


RESULTS
Mortality was 41.4% (44.7% in ruptured aneurysms alone). The following were negative preoperative prognostic factors: old age, hypertension, ASA V, intraoperative anuria and platelet count <100,000. Intraoperative factors included: hypotension, cardiac arrest, onset of anuria, aortic clamping in more than one site, duration of surgery, quantity of RBC and plasma transfused. The main postoperative variables correlated to mortality were: hypotension, hypothermia, onset of anuria, need for further transfusions, high creatinine levels.


CONCLUSIONS
Rapid intervention can minimise mortality in structures with expert teams of surgeons and anesthetists experienced in treating this type of pathology.
Merlo
M
M
Vascular Surgery Unit, Emergency Anesthesia and Reanimation Unit, San Giovanni Battista Hospital, Turin, Italy.
Carignano
G
G
Bitossi
G
G
Leotta
L
L
Mussano
L
L
Levi
S
S
Bau
G
G
Narcisi
P
P
Russo
L
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors