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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2009 September;16(3):163-77
Open repair for ruptured abdominal aortic aneurysms
Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
Open repair for ruptured abdominal aortic aneurysm (RAAA) is still a challenging unsolved problem which has maintained an high mortality rate during the last decades despite the advance on prehospital management and transfer, short emergency department diagnostic evaluation, aneurysm repair by an operating vascular surgery team and sophisticated postoperative care. This high mortality seems to be related to the combined injury of a period of hemorrhagic shock and lower torso ischaemia followed by a reperfusion injury on successful revascularization. This ’two hit’ mechanism of injury, initiates a systemic inflammatory response syndrome, characterized by increased microvascular permeability and neutrophil sequestration, leading to a multiple organ dysfunction syndrome, which is the primary cause of 70% of deaths and a contributory cause of the remainder. No preoperative factors or scoring systems have been identify to predict outcome in these patients. Prevention seems to be the treatment of choice for RAAA. Screening with ultra sound appears to be a cost-effective strategy that has been demonstrated to reduce the incidence of RAAA. Endovascular aortic repair has been proposed as an alternative approach to treat RAAA. Its role is interesting and still on debate. The potential advantages of the endovascular procedure respect open repair has been shown to be reduction in blood loss, transfusion, length of intensive care unit stay and makes this procedure attractive and potentially helpful in reducing the mortality rate of RAAA. Further study are needed to definitely demonstrate these advantages respect open repair.