THE RUPTURE TYPE DETERMINES THE OUTCOME FOR RUPTURED ABDOMINAL AORTIC-ANEURYSM PATIENTS

Background: The treatment of patients with ruptured abdominal aortic a neurysms (RAAA) poses a significant surgical challenge. To achieve imp rovement in survival, factors influencing case fatality must be identi fied and modified. The aim of the present survey was to determine the contribution of preoperative, perioperative and postoperative events i n predicting the mortality among AAA patients undergoing an emergency operation. Material and Methods: Fifty-one consecutive patients with r uptured infrarenal abdominal aortic aneurysm and twenty-six patients w ith 'expanding symptomatic aneurysms' (EAAA) were reviewed retrospecti vely to determine the relative contributions of preoperative, perioper ative and postoperative factors on mortality. Results and conclusions: The 30-day mortality was 47 % in the RAAA group and 12 % in the EAAA group. The rupture type was the main predictor of the outcome for the RAAA patients, the mortalities being 88 % and 29 % among patients with free (n = 16) and contained (n = 35) ruptures, respectively. In concl usion, the best way of avoiding poor results in cases of emergency ane urysm repair is to aim at elective operations. After the rupture, the clinical course is mainly determined by the rupture type, which is unf ortunately beyond the surgeon's control. Surgical expertise and the av oidance of technical error can significantly affect the survival.