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Giornale Italiano di Chirurgia Vascolare 2000 June;7(2):81-93

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English, Italian

Chronic contained rupture of abdominal aortic aneurysms

Ippoliti A., Lorido A., Battistini M., Marchetti T., Pistolese G. R.

From the Department of Postgraduate School of Vascular Surgery “Tor Vergata” University of Rome, Rome, Italy


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Background. To eval­u­ate on the ­basis of our expe­ri­ence in 12 ­patients ­with chron­ic con­tained rup­ture (CCR) of an abdom­i­nal aor­tic aneu­rysm, the aetio­path­o­gen­e­sis of the dis­ease, its clin­i­cal pres­en­ta­tion, its diag­no­sis and the ­results of sur­gery.
Methods. From January 1990 to June 1999 a ­total of 768 ­patients under­went sur­gery for abdom­i­nal aor­tic aneu­rysm: 662 (86.2%) ­were oper­at­ed elec­tive­ly and 106 (13.8%) in emer­gen­cy. Six hun­dred and fif­ty-­four (85.1%) ­patients pre­sent­ed an aneu­rysm with­out fis­su­ra­tion or rup­ture (Group A), 102 (13.3%) ­showed a fis­sured aneu­rys­mat­ic sac (Group B) and 12 (1.6%) pre­sent­ed CCR (Group C). Age, gen­der, ­risk fac­tors, asso­ciat­ed vas­cu­lar dis­ease and out­come of sur­gery ­were com­pared in the ­three ­groups and the ana­tom­ic and clin­i­cal char­ac­ter­is­tics of ­patients ­with CCR ­were exam­ined.
Results. No sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­enc­es ­were ­found ­between the 3 ­groups for ­risk fac­tors or asso­ciat­ed vas­cu­lar dis­ease. Patients ­with CCR are ­often nor­mo­ten­sive and ­show small­er ret­ro­per­i­to­neal hae­mat­o­ma com­pared to ­patients in Group B. Operative mor­tal­ity in Groups A, B and C was respec­tive­ly 3, 41.2 and 8.3%.
Conclusions. Owing to its pos­sible evo­lu­tion ­into ­free rup­ture, CCR ­calls for rap­id diag­no­sis and treat­ment. CT is the ­most reli­able ­means of diag­no­sis. Patients ­with CCR are ­more ­often nor­mo­ten­sive and ­present small­er ret­ro­per­i­to­neal hae­mat­o­mas com­pared to rup­tured aneu­rysm. Retroperitoneal drain­age is rec­om­mend­ed, togeth­er ­with bac­te­ri­al cul­ture of the hae­mat­o­ma and ­more fre­quent post­op­er­a­tive con­trols to pre­vent ­graft infec­tion.

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