Ruptured infrarenal aortic aneurysm - a critical evaluation

Background: Objective evaluation of the management of patients with rupture d infrarenal aortic aneurysm in emergency situations has been described rar ely. Patients and methods: Fifty-two consecutive patients with ruptured infraren al aortic aneurysm (mean age, 70.3 years; range, 56-89 years; SD 7.8) were admitted between January 1993 and March 1998. Emergency protocols, final re ports, and follow-up data were analyzed retrospectively. APACHE II scores a t admission and fifth postoperative day were assessed Results: The time between the appearance of first symptoms and the referral of patients to the hospital was more than 5 hours in 37 patients (71%). Th irty-eight patients (71%) had signs of shock at time of admission. Ultrasou nd was performed in 81% of patients as the first diagnostic procedure. The most frequent site of aortic rupture was the left retroperitoneum (87%). In traoperatively, acute left ventricular failure occurred in four patients, a nd cardiac arrest in two others. The postoperative course was complicated s ignificantly in 34 patients, The overall mortality rate was 36.5% (n = 19). In 35 patients, APACHE II score was assessed, showing a probability of dea th of more than 40% in five patients find lower than 30% in 17 others. No p atient showing probability of death of above 75% at the fifth postoperative day survived (n = 7). Conclusions: Ruptured aortic aneurysm demands surgical intervention. Clinic al outcome is also influenced by preclinical and anesthetic management. The severity of disease as well as the patient's prognosis can be approximated using APACHE II score. Treatment results of heterogenous patient groups ca ll be compared.