Risk Factors for Survival Following Open Surgical Repair of Ruptured Abdominal Aortic Aneurysms: A 13-Year Experience

Overview

Journal J Tehran Heart Cent

Publisher Tehran University of Medical Sciences

Specialty Cardiology & Vascular Diseases

Date 2015 Dec 24

PMID 26697083

Citations 2

Authors

Anil Ozen

Muhammet Onur Hanedan

Cetin Murat Songur

Emre Boysan

Ertekin Utku Unal

Serkan Mola

Halil Ibrahim Erkengel

Emre Kubat

Zafer Iscan

Ufuk Tutun

Ahmet Saritas

Cemal Levent Birincioglu

Affiliations

Soon will be listed here.

Abstract

Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA.

Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality.

Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively).

Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs.

Citing Articles

Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score).

Berchiolli R, Troisi N, Bertagna G, DOria M, Mezzetto L, Malquori V J Clin Med. 2024; 13(5).

PMID: 38592197 PMC: 10934212. DOI: 10.3390/jcm13051384.

Systematic review of plasma/packed red blood cell ratio on survival in ruptured abdominal aortic aneurysms.

Phillips A, Tran L, Foust J, Liang N J Vasc Surg. 2020; 73(4):1438-1444.

PMID: 33189763 PMC: 8005448. DOI: 10.1016/j.jvs.2020.10.027.

References

Bickell W, Wall Jr M, Pepe P, Martin R, Ginger V, Allen M . Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994; 331(17):1105-9. DOI: 10.1056/NEJM199410273311701. View

Heikkinen M, Salenius J, Auvinen O . Ruptured abdominal aortic aneurysm in a well-defined geographic area. J Vasc Surg. 2002; 36(2):291-6. DOI: 10.1067/mva.2002.125479. View

Nakayama A, Morita H, Miyata T, Hoshina K, Nagayama M, Takanashi S . Predictors of mortality after emergency or elective repair of abdominal aortic aneurysm in a Japanese population. Heart Vessels. 2013; 29(1):65-70. DOI: 10.1007/s00380-012-0319-5. View

Gullu A, Burnaz T, Okten E, Senay S, Ariturk C, Toraman F . Emergent endovascular repair of ruptured abdominal and thoracic aortic aneurysms in a single center: midterm outcomes. Chirurgia (Bucur). 2015; 109(6):753-7. View

Harris L, Faggioli G, Fiedler R, Curl G, Ricotta J . Ruptured abdominal aortic aneurysms: factors affecting mortality rates. J Vasc Surg. 1991; 14(6):812-8; discussion 819-20. DOI: 10.1067/mva.1991.33494. View

Ricotta 2nd J, Malgor R, Oderich G . Ruptured endovascular abdominal aortic aneurysm repair: part II. Ann Vasc Surg. 2010; 24(2):269-77. DOI: 10.1016/j.avsg.2009.08.009. View

Anain P, Anain Sr J, Tiso M, Nader N, Dosluoglu H . Early and mid-term results of ruptured abdominal aortic aneurysms in the endovascular era in a community hospital. J Vasc Surg. 2007; 46(5):898-905. DOI: 10.1016/j.jvs.2007.06.037. View

Tilney N, Bailey G, Morgan A . Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg. 1973; 178(2):117-22. PMC: 1355616. DOI: 10.1097/00000658-197308000-00001. View

Bown M, Sutton A, Bell P, Sayers R . A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg. 2002; 89(6):714-30. DOI: 10.1046/j.1365-2168.2002.02122.x. View

10.

Ohki T, Veith F . Endovascular grafts and other image-guided catheter-based adjuncts to improve the treatment of ruptured aortoiliac aneurysms. Ann Surg. 2000; 232(4):466-79. PMC: 1421179. DOI: 10.1097/00000658-200010000-00002. View

11.

Mehta M, Taggert J, Darling 3rd R, Chang B, Kreienberg P, Paty P . Establishing a protocol for endovascular treatment of ruptured abdominal aortic aneurysms: outcomes of a prospective analysis. J Vasc Surg. 2006; 44(1):1-8. DOI: 10.1016/j.jvs.2006.02.057. View

12.

Powell J, Sweeting M, Thompson M, Ashleigh R, Bell R, Gomes M . Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ. 2014; 348:f7661. DOI: 10.1136/bmj.f7661. View

13.

Alric P, Ryckwaert F, Picot M, Branchereau P, Colson P, Mary H . Ruptured aneurysm of the infrarenal abdominal aorta: impact of age and postoperative complications on mortality. Ann Vasc Surg. 2003; 17(3):277-83. DOI: 10.1007/s10016-001-0407-y. View

14.

Dueck A, Kucey D, Johnston K, Alter D, Laupacis A . Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors. J Vasc Surg. 2004; 39(6):1253-60. DOI: 10.1016/j.jvs.2004.02.006. View

15.

Noel A, Gloviczki P, Cherry Jr K, Bower T, Panneton J, Mozes G . Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair. J Vasc Surg. 2001; 34(1):41-6. DOI: 10.1067/mva.2001.115604. View

16.

Ernst C . Abdominal aortic aneurysm. N Engl J Med. 1993; 328(16):1167-72. DOI: 10.1056/NEJM199304223281607. View

17.

Crawford E . Ruptured abdominal aortic aneurysm. J Vasc Surg. 1991; 13(2):348-50. DOI: 10.1016/0741-5214(91)90228-m. View

18.

Zeng Q, Yang G, Liu C, Ni L, Lai Z . Comparison of endovascular aortic repair and open surgical repair for ruptured abdominal aortic aneurysm. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015; 36(6):624-8. DOI: 10.3881/j.issn.1000-503X.2014.06.012. View

19.

Johansen K, Kohler T, Nicholls S, Zierler R, Clowes A, Kazmers A . Ruptured abdominal aortic aneurysm: the Harborview experience. J Vasc Surg. 1991; 13(2):240-5; discussion 245-7. View

20.

Roberts K, Revell M, Youssef H, Bradbury A, Adam D . Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2006; 31(4):339-44. DOI: 10.1016/j.ejvs.2005.11.003. View