EXPERIENCE IN MANAGING 70-PATIENTS WITH RUPTURED ABDOMINAL AORTIC-ANEURYSMS

Seventy cases of ruptured abdominal aortic aneurysms (RAAAs) repaired over a 14-year period from 1975 to 1989 were analyzed. Age, heart disease, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, or specific postoperative complications did not correlate with mortality. If the time interval from arrival at the hospital to skin incision (emergency room (ER) or operating room (OR)) was less than six hours, there was no correlation with survival. Mortality correlated significantly with admitting systolic blood pressure, blood pressure at the time of skin incision, a comparison of ER to OR time of less than or more than six hours, blood loss of less than compared to more than ten units, and time in the operating room of less than five hours compared to more than five hours. Both time in the operating room and blood loss correlated with technical problems. Prior to 1985, 11 general and vascular surgeons had repaired RAAAs with a mortality of 76%. Since 1985, six vascular surgeons repaired RAAAs with a significant decrease in mortality (54%). Our data indicate that patients profoundly hypotensive on admission or at the time of incision are unlikely to survive regardless of other factors; patients with a systolic blood pressure greater than 100 mm Hg have the best chance of survival; a delay of up to six hours prior to surgery in patients with a systolic blood pressure than 100 mm Hg does not increase mortality; and a smaller number of surgeons operating on RAAAs increases survival. Based on these observations, we recommend that patients with a suspected RAAA and a systolic blood pressure greater than 100 mm Hg be brought to centers with surgeons experienced in RAAAs or transferred to such facilities within six hours and that such centers designate specific surgeons with an interest in RAAAs to develop the expertise to handle these cases.