Abdominal vascular emergency surgery: Abdominal aortic aneurysm, acute mesenteric ischemia - Indication, technique, results

Ruptured infrarenal aortic aneurysms and mesenteric ischemia are abdominal emergency situations, which should be treated by vascular surgeons. Modern means of patient transport and specialized emergency centers make it possib le to bring patients suspect of having a ruptured aneurysm or a mesenteric ischemia to experienced clinics. Indication for surgery in case of symptoma tic or ruptured aortic aneurysms is doubtless absolute. If there is suspici on for a ruptured aneurysm, emergency operation is indicated. In patients h aving undergone emergency surgery for a ruptured aneurysm of the infrarenal aorta, hospital mortality was 41%. The initial indication for surgery for patients with mesenteric ischemia usually is the "acute abdomen". Mostly on ly the patient's history reveals the suspicion for this disease. There are no valid radiologic examinations for proving or ruling out mesenteric ische mia. Most of our patients had arterial embolism (64%) as a source of mesent eric ischemia, followed by arterial thrombosis (28%), venous thrombosis (3% ) and nonocclusive ischemia (5%). Monitoring of levels of serum lactate can be an additional tool for decision making, if a second look operation is d iscussed. The key for surgical success with these critically ill patients i s shortening of the interval between the first symptoms of the patient and the start of surgical therapy.