Twelve-year experience of the management of ruptured abdominal aortic aneurysm

Background The operative mortality rate for elective repair of asymptomatic abdominal aortic aneurysm (AAA) is falling but the fate of patients with ruptured AAA may have changed little over the past decade. Methods This study was an analysis of a prospectively gathered computerized database. Results In the 12 years to 31 December 1994, 1144 patients underwent (attempted) repair of AAA. In 514 patients (44.9 per cent) who had an operation for ruptured AAA there was no significant change in the mean age, male:female ratio (418:96), or operative mortality rate (35.0 per cent) over the interval of the study. Forty-seven patients died before reaching the operating theatre, giving an 'intention to operate' mortality rate of 40.5 per cent. A further 68 patients (10.8 per cent of all patients who presented with a ruptured AAA) were not offered operation because of poor medical condition (n = 34) or extreme age (n = 34); three patients refused operation. A greater proportion of patients had surgery between 1989 and 1994 (276 of 323, 85.4 per cent) than between 1953 and 1988 (238 of 309, 77.0 per cent) (P < 0.01, chi(2) test). Conclusion The proportion of aneurysms operated on for rupture in this unit remains high (almost 50 per cent). The results of surgery for ruptured AAA have not improved in the past 12 years.