Impact of intraoparetive parametres on survival of patients with ruptured abdominal aortic aneurysm
Authors: Markovic Miroslav , Davidovic Lazar , Maksimovic Zivan , Kostic Dusan , Pejkic Sinisa , Kuzmanovic Ilija , Djoric Predrag , Jakovljevic Nenad , Lotina Slobodan 
Published: July 2008

Ruptured abdominal aortic aneurysm is one of the most urgent surgical conditions with high mortality that has not been changed in decades. Between 1991-2001 total number of 1058 patients was operated at the Institute for Cardiovascular Diseases of Clinical Center of Serbia due to abdominal aortic aneurysm. Of this number, 288 patients underwent urgent surgical repair because of ruptured abdominal aortic aneurysm. The aim of this retrospective study was to show results of the early outcome of surgical treatment of patients with ruptured abdominal aortic aneurysm, and to define relevant intraoperative factors that influence their survival. There were 83% male and 17% female patients in the study, mean aged 67 years. Mean duration of surgical procedure was 190 minutes (75-420 min). Most common localization of aneurysm was infrarenal - in 74% of patients, then juxtarenal (12.3%). Suprarenal aneurysm was found in 6.8% of patients, as well as thoracoabdominal aneurysm (6.8%). Retroperitoneal rupture of aortic aneurysm was most common - in 65% of patients, then intraperotineal in 26%. Rare finding such as chronic rupture was found in 3.8%, aortocaval fistula in 3.2% and aorto-duodenal fistula in 0.6% of patients. Mean aortic cross-clamping time was 41.7 minutes (10-150 min). Average intraoperative systolic pressure in patients was 106.5 mmHg (40-160 mmHg). Mean intraoperative blood loss was 3700 ml (1400-8500 ml). Mean intraoperative diuresis was 473 ml (0-2100 ml). Tubular graft was implanted in 53% of patients, aortoiliac bifurcated graft in 32.8%. Aortobifemoral reconstruction was done in 14.2% of patients. These data refer to the patients that survived surgical procedure. Intrahospital mortality that included intraoperative and postoperative deaths was 53.7%. Therefore, 46.3% patients survived surgical treatment and were released from the hospital. Intraoperative mortality was 13.5%. Type of aneurysm had no influence on outcome of patients (p>0.05), as well as type of rupture and level of aortic cross-clamping. Aortic cross-clamping time was significantly shorter in survivors, and longest in patients that died intraoperatively (p<0.05). Intraoperative systolic tension value influenced the outcome in patients; it was significantly higher in survivors (p<0.01). Interposition of tubular graft gave better results compared with aorto-iliac and aorto-femoral reconstruction (p<0.01). Duration of surgery was significantly higher in patients with lethal outcome (p<0.05), as well as intraoperative blood loss (p<0.05). Intraoperative diuresis was significantly lower in patients with lethal outcome (p<0.05). Ruptured abdominal aortic aneurysm still remains one of the most dramatic surgical states with very high mortality. Important intraoperative factors that influence the outcome of surgical treatment can be defined. Therapeutic efforts should be concentrated on those factors that are possible to correct, which would hopefully lead to better survival of patients. Nevertheless, screening for abdominal aortic aneurysm and elective surgical intervention before rupture occurs should be the best solution for this complex problem.