Aneurisma abdominal roto

Interactive cardiovascular and thoracic surgery, 2009

The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynamic parameters on the immediate outcome after repair of ruptured abdominal aortic aneurysm (RAAA). This is a retrospective review of 68 consecutive patients who underwent emergency repair of RAAA. Baseline pulmonary artery pressure, cardiac index, oxygen saturation and pulse rate were measured and recorded immediately after insertion of a pulmonary artery thermodilution catheter and before anaesthesia induction. The in-hospital mortality rate was 39.7%. The area under the receiver operating characteristic (ROC) curve of cardiac index was 0.74 (95% CI 0.61-0.86), of stroke volume index was 0.78 (95% CI 0.67-0.89) and for oxygen delivery 0.72 (95% CI 0.60-0.84) for prediction of in-hospital death. The best cut-off values of cardiac index was 2.7 l/min/m(2) (18.8% vs. 58.3%, OR 6.07, 95% CI 2.00-18.37), of stroke volume index was 27 ml/m(2) (23.1% vs. 62.1%, OR 5.46, 95% CI 1.90-15.70) and of...

Aim: The aim of this study was to evaluate the impact of preoperative cardiac function and haemodynamic parameters on the immediate outcome after repair of ruptured abdominal aortic aneurysm (RAAA). Methods: This is a retrospective review of 68 consecutive patients who underwent emergency repair of RAAA. Baseline pulmonary artery pressure, cardiac index, oxygen saturation and pulse rate were measured and recorded immediately after insertion of a pulmonary artery thermodilution catheter and before anaesthesia induction. Results: The in-hospital mortality rate was 39.7%. The area under the receiver operating characteristic (ROC) curve of cardiac index was 0.74 (95% CI 0.61-0.86), of stroke volume index was 0.78 (95% CI 0.67-0.89) and for oxygen delivery 0.72 (95% CI 0.60-0.84) for prediction of in-hospital death. The best cut-off values of cardiac index was 2.7 lyminym (18.8% vs. 58.3%, OR 6.07, 95% CI 2.00-18.37), of stroke 2

Background: Abdominal aortic rupture is a lethal event. It is estimated that 80% of the mortality secondary to abdominal aortic aneurysm (AAA) is secondary to rupture. Surgeons would like to be able to predict with certainty which patients will survive surgical repair and return to a functional life with a minimum of complications. Objective: To analyze the multiple factors assumed to influence the outcome of operative treatment of RAAA at the Clinic for Vascular Surgery KCUS and to determine which of these factors has a significant impact on survival. Materials and methods: We performed this retrospective observation study on 49 patients treated at the Clinic for Vascular Surgery for RAAA in the period from 2004 to 2010. We compared the group of patients that survived the operation (33 patients) with the group who underwent surgery but died intraoperatively or within 30 days postoperatively (16 patients). In both groups of patients we measured and compared the period from the occurrence of symptoms until arrival, preoperative values of blood pressure, pulse, state of consciousness, diuresis, and laboratory findings such as hemoglobin, urea and creatinine, comorbidities such as cardiomyopathy, respiratory or renal failure, the duration of surgery, the duration of aortic clamping, and units of transfunded blood. Results: Operative mortality was 32.6% and intraoperative mortality was 4%. We found blood pressure less than 85/60 mmHg, hemoglobin less than 85g/l, kreatinin above 175 mmol/l, duration of operation more than 5h and duration of aortic cross clamping more than 2h as significant predictors of mortality, as well as loss of consciousness, severe cardio-myopathy and anuria on arrival. Conclusion: Currently, there is no recommendation to withhold surgery for patients with any or all of these risk factors; this decision is made on a case-by-case basis, making risk factor analysis useful mostly from the standpoint of guiding patient decisions regarding surgery and family discussions on prognosis.

Annals of Vascular Surgery, 2009

Journal of Vascular Surgery, 1996

This study evaluated perioperative variables to predict death in nonruptured and ruptured abdominal aortic aneurysm (AAA) surgery. Methods: A consecutive review of all patients who tmderwent AAA surgery from January 1984 to December 1993 was carried out. Perioperative variables were analyzed with univariate and multivariate statistical models to predict mortality rates. Results: Four hundred seventy-eight patients with nonruptured AAAs and 157 patients with ruptured AAAs were studied. In patients with nonruptured AAAs, the mortality rate was 3.8%. Using stepwise logistic regression analysis, independent predictors of death were perioperative myocardial infarction (odds ratio [OR], 5.0; p < 0.01), prolonged postoperative ventilation (OR, 4.0; p < 0.01), history of peripheral vascular disease (OR, 2.9; p < 0.01), preoperative renal dysfimction (OR, 2.7; p < 0.01), and history of congestive heart failure (OR, 2.6; p < 0.03). In patients with ruptured AAAs, the mortality rate was 46%. Analysis of preoperative variables using multivariate stepwise logistic regression found predictors of death to be preoperative unconsciousness (OR, 3.1; p < 0.01), advanced age (OR, 1.9; p < 0.01), and cardiac arrest (OR, 1.8; p < 0.05). In patients who survived the initial surgery for ruptured AAA, a second stepwise logistic regression model found independent predictors for subsequent postoperative death to be coagulation disorder (OR, 7.9; p < 0.01), ischemic colitis (OR, 6.4; p < 0.01), inotropic support beyond 48 hours (OR, 4.8; p < 0.01), delayed transport to operating room (OR, 4.6; p < 0.01), advanced age (OR, 4.4; p < 0.01), perioperative myocardial infarction (OR, 4.0; p < 0.05) and postoperative renal dysfunction (OR, 3.7; p < 0.01). Conclusion: Prolonged ventilation, perioperative myocardial infarction, a history of peripheral vascular disease, preoperative renal dysfunction, and a history of congestive heart failure are independent predictors of perioperative death in patients with nonruptured AAAs. For patients with ruptured AAAs, mortality rates can be estimated before surgery using age, level of consciousness, and cardiac arrest. For patients who survive the initial surgery for ruptured AAA, subsequent mortality rates can also be predicted.

Journal of Vascular Surgery, 1998

Purpose: Long-term survival and late vascular complications in patients who survived repair of ruptured abdominal aortic aneurysms (RAAA) is not well known. The current study compared late outcome after repair of RAAA with those observed in patients who survived elective repair of abdominal aortic aneurysms (AAA). Methods: The records of 116 patients, 102 men and 14 women (mean age: 72.5 (8.3 years), who survived repair of RAAA (group I) between 1980 to 1989 were reviewed. Late vascular complications and survival were compared with an equal number of survivors of elective AAA repair matched for sex, age, surgeon, and date of operation (group II). Survival was also compared with the age and sex-matched white population of west-north central United States. Results: Late vascular complications occurred in 17% (20/116) of patients in group I and in 8% (9/116) in group II. Paraanastomotic aneurysms occurred more frequently in group I than in group II (17 vs. 8, p = 0.004). At follow-up, 32 patients (28%) were alive in group I (median survival: 9.4 years) and 53 patients (46%) were alive in group II (median survival . Cumulative survival rates after successful RAAA repair at 1, 5, and 10 years were 86%, 64%, and 33%, respectively. These were significantly lower than survival rates at the same intervals after elective repair (97%, 74%, and 43%, respectively, p = 0.02) or survival of the general population (95%, 75%, and 52%, respectively, p < 0.001). Coronary artery disease was the most frequent cause of late death in both groups. Vascular and graft-related complications caused death in 3% (3/116) in group I and 1% (1/116) in group II. Cox proportional hazards modeling identified age (p = 0.0001), cerebrovascular disease (p = 0.009), and number of days on mechanical ventilation (p = 0.01) to be independent prognostic determinants of late survival in group I. Conclusions: Late vascular complications after repair of RAAA were higher and late survival rates lower than after elective repair. These data support elective repair of AAA. As two-thirds of the patients discharged after repair of RAAA are alive at 5 years, aggressive management of RAAA remains justified. (J Vasc Surg 1998;27:813-20.)

Journal of Vascular Surgery, 1985

Journal of Surgical Research, 2001

Purpose. The aim of this study was to define whether veterans who survived repair of ruptured abdominal aortic aneurysms (AAA) experienced late survival rates similar to those surviving repair of intact AAA.

Journal of Endovascular Therapy, 2009

To compare endovascular (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysms (RAAA) in terms of preoperative hemodynamic status and comorbidities. Methods: The 2005 to 2007 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was interrogated to find all patients undergoing repair for RAAA. Of the 567 RAAA repairs identified, 121 (21%) were endovascular and 446 (79%) were open. Demographics, comorbidities, and preoperative hemodynamic status were compared by repair method. Results: Age, sex, and race were similar between repair cohorts. EVAR patients had greater incidences of recent myocardial infarction (7% versus 2%, p,0.05), revascularization or amputation for peripheral vascular disease (8% versus 3%, p,0.05), and cerebrovascular disease (22% versus 11%, p,0.01). Preoperative hemodynamic status was similar based on need for .4 units of blood (3% versus 6%, p50.31), intubation (12% versus 17%, p50.18), impaired sensorium (7% versus 11%, p50.25), coma (4% versus 5%, p50.65), acute renal failure (2% versus 2%, p50.60), and ASA class 5 (29% versus 34%, p50.29). Open repair was associated with greater operative time (3.3 versus 2.6 hours, p,0.01) and intraoperative blood transfusions (8 versus 2 units, p,0.001). Overall mortality was 33.5% (EVAR 24% versus OSR 36%; OR 1.8, 95% CI 1.1 to 2.8, p,0.05). After adjusting for preoperative comorbidities and all preoperative hemodynamic variables, mortality after open repair was greater than after EVAR (OR 1.9, 95% CI 1.1 to 3.2, p,0.05). Overall postoperative complications were greater after open repair (62% versus 47%, p,0.01). Graft failure requiring reintervention was higher after EVAR (4% versus 1%, p,0.05), while rates of return to the operating room for a major operation were similar (21% versus 24%, p50.43). Conclusion: For RAAA within NSQIP hospitals in recent years, preoperative hemodynamic status was similar between EVAR and OSR, but EVAR patients had greater comorbidities. Despite this and after accounting for minor differences in hemodynamic status, EVAR The annual ISES Endovascular Research Competition held on February 9, 2009, at International Congress XXII on Endovascular Interventions (Scottsdale, Arizona, USA) evaluated participants on both their oral and written presentations. ISES congratulates the 2009 winners.

Journal of Vascular Surgery, 2009

Objective: To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surgery. Methods: In a multicenter prospective observational study, 233 consecutive patients with ruptured AAAs were evaluated; 32 patients did not survive to repair and statistical analysis was performed using collected data on 201 patients. All patients who were treated with endovascular repair (n ‫؍‬ 58) or open surgery (n ‫؍‬ 143) were included. The GAS was calculated for each patient. The area under the receiver operating characteristics curve (AUC) was used to indicate discriminative ability. We tested for interactions between risk factors and the procedure performed. The GAS was updated to predict 30-day mortality after endovascular repair or open surgery in patients with ruptured AAAs using logistic regression analysis.