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A Journal on Internal Medicine

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Panminerva Medica 1998 December;40(4):309-13

language: English

Rup­tured abdom­i­nal aor­tic aneu­rysms: fac­tors affect­ing the ear­ly post­op­er­a­tive out­come

Miani S., Giorgetti P. L., Giordanengo G., Tealdi D.

From the Institute of General and Cardiovascular Surgery, Uni­ver­sity of ­Milan, ­Milan, Ita­ly
* “Edmon­do Mal­an”Cen­ter, San Dona­to Mil­a­nese Hos­pi­tal, Ita­ly


Back­ground. In ­spite of the ­progress in diag­no­sis and treat­ment of rup­tured abdom­i­nal aor­tic aneu­rysms (­RAAA) the mor­tal­ity ­rate ­still ­remains ­very ­high (var­y­ing ­from 15% to 50% accord­ing to var­i­ous expe­ri­enc­es). ­This ­study is ­aimed at ana­lyz­ing the rel­a­tive con­tri­bu­tion of pre­op­er­a­tive hemo­dy­nam­ic con­di­tions and of oper­a­tive and post­op­er­a­tive fac­tors to out­come of ­patients oper­at­ed on for rup­tured abdom­i­nal aor­tic aneu­rysms.
Meth­ods. For ­this pur­pose a ret­ro­spec­tive ­case ­series involv­ing 152 ­patients oper­at­ed on in emer­gen­cy for ­RAAA, dur­ing the peri­od 1990-1994, has ­been ­reviewed. In ­this ­group we exam­ined the ­site of rup­ture, the ­size of the aneu­rysms, the pres­ence or not of a ­shock con­di­tion at admis­sion, the exis­tence of inflam­ma­to­ry ­aspects, the adopt­ed ­type of pros­the­sis.
­Results. The mor­tal­ity ­rate was 24.3% (37 ­patients).
In 10 ­patients (27%) the ­cause of ­death was an irre­ver­sible hemor­rhag­ic ­shock. ­Eight ­patients (21.6%) ­died for an intes­ti­nal infarc­tion. In 7 ­patients the ­fatal out­come was due to the devel­op­ment of an ­acute ­renal fail­ure. ­Five ­patients (13.5%) under­went an ­acute myo­car­dial infarc­tion and oth­er ­five a mul­ti­or­gan fail­ure. Two ­patients (5.5%) even­tu­al­ly ­died for res­pir­a­to­ry insuf­fi­cien­cy.
Con­clu­sions. The ­results of our ­study ­seem to con­firm ­that ­ the out­come of ­patients affect­ed by rup­ture of abdom­i­nal aor­tic aneu­rysms ­depends not ­only on the pre­op­er­a­tive hemo­dy­nam­ic con­di­tion but ­also on the exper­tise of the sur­gi­cal ­team.

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