RUPTURED ABDOMINAL AORTIC-ANEURYSMS - PREDICTORS FOR EARLY COMPLICATIONS AND DEATH

Background. Urgent operation for ruptured aneurysm is still associated with a high operative mortality rate. The purpose of the study was to determine the risk factors that truly influence early complications a nd death. Methods. Between 1979 and 1991, 314 consecutive patients wit h a mean age of 69 years were treated surgically for a ruptured infrar enal abdominal aortic aneurysm. Twenty-two preoperative, perioperative , and intraoperative variables were subjected to a multivariate analys is to identify the independent predictors.Results. Early death occurre d in 92 (29%) of 340 patients. Significant primary predictors for earl y death were duration of cross-clamp (p < 0.0001), preoperative shock (p = 0.0005), suprarenal cross clamp (p = 0.002), and a history of cor onary artery disease (CAD) (p = 0.004). The following postoperative co mplications were risk factors for death: myocardial failure (p < 0.000 1), renal failure (p < 0.0001), sepsis (p = 0.01), and colon ischemia (p = 0.03). Predictors for postoperative myocardial insufficiency were a history of CAD (p < 0.0001), amount Of intraoperative volume substi tution (p < 0.0001), suprarenal cross clamp (p = 0.0007), and preopera tive shock (p = 0.05). Conclusions. Preoperative and perioperative ris k factors that result in fatal postoperative complications can be part ially influenced by the surgeon. Short clamping time and infrarenal po sition of aortic clamp may lower overall early mortality rates. A hist ory of CAD is a highly significant predictor for postoperative complic ations and early death.