Regular Article
Ruptured Abdominal Aortic Aneurysms: Selecting Patients for Surgery

https://doi.org/10.1053/ejvs.1998.0718Get rights and content
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Abstract

Objectives: mortality from ruptured abdominal aortic aneurysm (RAAA) remains high. Despite this, withholding surgery on poor-prognosis patients with RAAA may create a difficult dilemma for the surgeon. Hardmanet al. identified five independent, preoperative risk factors associated with mortality and proposed a model for preoperative patient selection. The aim of this study was to test the validity of the same model in an independent series of RAAA patients.Methodsa consecutive series of patients undergoing surgery for RAAA was analysed retrospectively by case-note review. Thirty-day operative mortality and the presence of the five risk factors: age (>76 years), creatinine (Cr) (>190μmol/l), haemoglobin (Hb) (<9 g/dl), loss of consciousness and electrocardiographic (ECG) evidence of ischaemia were recorded for each patient.Results:complete data sets existed for 69 patients (mean age: 73 years, range: 38–86 years, male to female ratio: 6:1). Operative mortality was 43%. The cumulative effect of 0, 1 and 2 risk factors on mortality was 18%, 28% and 48%, respectively. All patients with three or more risk factors died (eight patients).Conclusions:these results lend support to the validity of the model. The potential to avoid surgery in patients with little or no chance of survival would spare unnecessary suffering, reduce operative mortality and enhance use of scarce resources.

Keywords

Abdominal aortic aneurysm
Rupture
Risk factors
Mortality.

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Please address all correspondence to: S. Ashley, Consultant Vascular Surgeon, Vascular Surgical Unit, Level 4, Derriford Hospital, Plymouth PL6 8DH, U.K.