The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Sep 9

PMID 37685601

Authors

Nicola Troisi

Giulia Bertagna

Lorenzo Torri

Francesco Canovaro

Mario DOria

Daniele Adami

Raffaella Berchiolli

Affiliations

Soon will be listed here.

Abstract

Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment.

Methods: we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies.

Results: the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention.

Conclusions: RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes.

Citing Articles

Ruptured abdominal aortic aneurysm managed using resuscitative endovascular balloon occlusion of the aorta with a two-stage approach.

Ishida K, Matsumura Y, Kitabayashi K, Ogawa H, Tajiri M, Ochi K Acute Med Surg. 2025; 12(1):e70048.

PMID: 39989484 PMC: 11843153. DOI: 10.1002/ams2.70048.

Initial signs in patients with ruptured abdominal aortic aneurysms: time for an expanded triad?.

Bergmark P, Sadeghi M, Talvitie M, Hultgren R Scand J Trauma Resusc Emerg Med. 2024; 32(1):94.

PMID: 39313802 PMC: 11421174. DOI: 10.1186/s13049-024-01268-0.

Modern management of ruptured abdominal aortic aneurysm.

Scali S, Stone D Front Cardiovasc Med. 2023; 10:1323465.

PMID: 38149264 PMC: 10749949. DOI: 10.3389/fcvm.2023.1323465.

References

Mohan P, Hamblin M . Comparison of endovascular and open repair of ruptured abdominal aortic aneurysm in the United States in the past decade. Cardiovasc Intervent Radiol. 2013; 37(2):337-42. DOI: 10.1007/s00270-013-0665-4. View

Jacomelli J, Summers L, Stevenson A, Lees T, Earnshaw J . Impact of the first 5 years of a national abdominal aortic aneurysm screening programme. Br J Surg. 2016; 103(9):1125-31. DOI: 10.1002/bjs.10173. View

Chen J, Hildebrand H, Salvian A, Taylor D, Strandberg S, Myckatyn T . Predictors of death in nonruptured and ruptured abdominal aortic aneurysms. J Vasc Surg. 1996; 24(4):614-20; discussion 621-3. DOI: 10.1016/s0741-5214(96)70077-0. View

Sonesson B, Dias N, Resch T . Is there an age limit for abdominal aortic aneurysm repair?. J Cardiovasc Surg (Torino). 2018; 59(2):190-194. DOI: 10.23736/S0021-9509.18.10344-2. View

Li B, Eisenberg N, Witheford M, Lindsay T, Forbes T, Roche-Nagle G . Sex Differences in Outcomes Following Ruptured Abdominal Aortic Aneurysm Repair. JAMA Netw Open. 2022; 5(5):e2211336. PMC: 9092206. DOI: 10.1001/jamanetworkopen.2022.11336. View

Lundgren F, Troeng T . Treatment choice and survival after ruptured abdominal aortic aneurysm: A population-based study. J Vasc Surg. 2020; 72(2):508-517.e11. DOI: 10.1016/j.jvs.2019.11.060. View

Kimball E, Adams D, Kinikini D, Mone M, Alder S . Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm. Vascular. 2009; 17(6):309-15. DOI: 10.2310/6670.2009.00048. View

Rayt H, Sutton A, London N, Sayers R, Bown M . A systematic review and meta-analysis of endovascular repair (EVAR) for ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2008; 36(5):536-44. DOI: 10.1016/j.ejvs.2008.08.008. View

Lilja F, Mani K, Wanhainen A . Editor's Choice - Trend-break in Abdominal Aortic Aneurysm Repair With Decreasing Surgical Workload. Eur J Vasc Endovasc Surg. 2017; 53(6):811-819. DOI: 10.1016/j.ejvs.2017.02.031. View

10.

Acosta S, Ogren M, Bengtsson H, Bergqvist D, Lindblad B, Zdanowski Z . Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. J Vasc Surg. 2006; 44(2):237-43. DOI: 10.1016/j.jvs.2006.04.037. View

11.

Garland B, Danaher P, Desikan S, Tran N, Quiroga E, Singh N . Preoperative risk score for the prediction of mortality after repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 2018; 68(4):991-997. DOI: 10.1016/j.jvs.2017.12.075. View

12.

Karthikesalingam A, Holt P, Vidal-Diez A, Ozdemir B, Poloniecki J, Hinchliffe R . Mortality from ruptured abdominal aortic aneurysms: clinical lessons from a comparison of outcomes in England and the USA. Lancet. 2014; 383(9921):963-9. DOI: 10.1016/S0140-6736(14)60109-4. View

13.

Markovic M, Davidovic L, Maksimovic Z, Kostic D, Cinara I, Cvetkovic S . Ruptured abdominal aortic aneurysm. Predictors of survival in 229 consecutive surgical patients. Herz. 2004; 29(1):123-9. DOI: 10.1007/s00059-004-2540-1. View

14.

Hemingway J, French B, Caps M, Benyakorn T, Quiroga E, Tran N . Preoperative risk score accuracy confirmed in a modern ruptured abdominal aortic aneurysm experience. J Vasc Surg. 2021; 74(5):1508-1518. DOI: 10.1016/j.jvs.2021.04.043. View

15.

Meldrum D, Moore F, Moore E, Franciose R, Sauaia A, Burch J . Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997; 174(6):667-72; discussion 672-3. DOI: 10.1016/s0002-9610(97)00201-8. View

16.

Heller J, Weinberg A, Arons R, Krishnasastry K, Lyon R, Deitch J . Two decades of abdominal aortic aneurysm repair: have we made any progress?. J Vasc Surg. 2000; 32(6):1091-100. DOI: 10.1067/mva.2000.111691. View

17.

Rasmussen T, Hallett Jr J, Noel A, Jenkins G, Bower T, Cherry Jr K . Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study. J Vasc Surg. 2002; 35(2):246-53. DOI: 10.1067/mva.2002.120384. View

18.

Lim S, Kwan S, Colvard B, dAudiffret A, Kashyap V, Cho J . Impact of interfacility transfer of ruptured abdominal aortic aneurysm patients. J Vasc Surg. 2022; 76(6):1548-1554.e1. DOI: 10.1016/j.jvs.2022.05.020. View

19.

Visser P, Akkersdijk G, Blankensteijn J . In-hospital operative mortality of ruptured abdominal aortic aneurysm: a population-based analysis of 5593 patients in The Netherlands over a 10-year period. Eur J Vasc Endovasc Surg. 2005; 30(4):359-64. DOI: 10.1016/j.ejvs.2005.05.005. View

20.

Neary W, Crow P, Foy C, Prytherch D, Heather B, Earnshaw J . Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm. Br J Surg. 2003; 90(4):421-5. DOI: 10.1002/bjs.4061. View