RUPTURED ABDOMINAL AORTIC-ANEURYSM - 6-YEAR FOLLOW-UP RESULTS OF A MULTICENTER PROSPECTIVE-STUDY

Purpose: On the basis of a prospective analysis of 147 patients underg oing surgery for ruptured abdominal aortic aneurysm (AAA) and recorded in the Canadian Society for Vascular Surgery Aneurysm Registry, this study defines the early and 6-year actuarial survival rates and determ ines the predictive variables that are associated with survival. Metho ds: Ongoing follow-up of a cohort of patients was current at the time of analysis. To identify the preoperative, intraoperative, and postope rative variables that were associated with survival, statistical metho ds included chi-squared analysis, logistic regression analysis, Kaplan -Meier analysis, and Cox regression analysis. Results: The survival ra te was 48.6% at 1 month, 34.7% +/- 4.2% at 3 years, and 22.0% +/- 4.0% at 6 years. When preoperative and intraoperative variables were consi dered and logistic regression analysis was used, the highest probabili ty of early in-hospital survival was associated with preoperative crea tinine levels of 1.3 mg/dl or less, intraoperative urine output of 200 mi or greater, and infrarenal clamp site. The highest probability of late survival, as calculated by the Cox proportional hazards method, w as predicted by the patient's age and total urine output during the pr ocedure. When all variables, including postoperative complications, we re considered, late survival was highest if intraoperative urine outpu t was 200 mi or greater and respiratory failure and myocardial infarct ion did not occur. For those patients with ruptured AAA who survived o peration (i.e., greater than 1 month), the long-term survival rate was significantly lower than a comparable group undergoing repair of nonr uptured AAA. Conclusions: Patients who survive repair of a ruptured AA A have a lower late survival rate than patients undergoing elective re pair. When a patient is evaluated before operation, no combination of preoperative variables could identify those patients with little or no chance of survival; hence, the decision to repair a ruptured AAA shou ld be made on clinical grounds. However, after surgery (when informati on on intraoperative and postoperative variables is also available), t he results of this study provide a basis for the surgeon to use these prognostic variables to assist clinical judgment and guide discussions on prognosis with the family and to identify those patients who have such a low chance of early and late survival that further aggressive t reatment may be futile.