Ruptured abdominal aortic aneurysms: The excessive mortality rate of conventional repair

Objective: Rupture of abdominal aortic aneurysms (AAAs) remains lethal. In a report of patients treated in the 1980s, we recommended aggressive manage ment. Cm continued experience prompted us to reevaluate this policy. Methods: We reviewed clinical variables affecting outcome, morbidity, morta lity, and trends in mortality of all patients managed at our institution wi th ruptured AAAs between;January 2, 1980, and November 30, 1998. Results: The study group included 413 consecutive patients, 339 men and 74 women. The mean age was 74.3 years (range, 49-96); 116 (28%) patients were older than 80 years. AAA was diagnosed before rupture in 119 (29%) patients . Eighty (19%) patients had preoperative cardiac arrest. Twenty-nine (7%) p atients died before operation; 65 (17%) died during the operation. The surg ical mortality rate (30-day) was 37%; the overall mortality rate was 45% an d was higher in women (68%) than in men (40%) (P < .001). Advanced age, APA CHE (Acute Physiology and Chronic Health Evaluation) II score, initial hema tocrit, and preoperative cardiac arrest were associated multivariately with 30-day mortality rates by means of stepwise logistic regression (P < .05). Twelve (23%) of 53 patients with cardiac arrest survived the operation. Lo gistic regression, adjusted for age, sex, and APACHE II score, demonstrated a decrease in overall and 30-day mortality rates (P < .001) over 18 years. The mean overall mortality rate was 51% from 1980 to 1984 and 42% from 199 4 to 1998. Conclusions: The mortality rate of ruptured AAAs remains excessive, despite improvement over 18 years. Patients older than 80 years with shock or card iac arrest have the highest mortality rate and should be evaluated for poss ible endovascular treatment. Because the diagnosis of AAA was unknown in mo re than 70% of patients, screening of the high-risk population and elective repair are recommended.