Aim: To present our management approach, complications, and mortality-related risk factors in patients diagnosed with ruptured abdominal aortic aneurysm (RAAA) who underwent open surgery. Materials and Methods: The charts of 39 patients with RAAA who underwent open surgery between September 2010 and August 2015 were reviewed retrospectively. Study population was divided into two groups; Group-1 (n=14) consisted of cases who died within 30 days after surgery and Group-2 (n=25) consisted of the survivors. Pre-, intra-, and postoperative factors related to mortality and morbidity were noted and statistically analyzed. Results: Of the 39 patients with a mean age of 68.9±9.5 years, 37 (94.9%) were males. Twelve patients with hypovolemic shock (30.8%) were taken into operation; and 56.4% of all study participants had infrarenal aneurysms. A total of 69.2% of the patients developed at least one complication, while 38.5% developed two or more complications. Two patients (5.1%) died in the intraoperative period, whereas 12 (30.8%) died within 30 days after the operation. Intraoperative aortic cross-clamp time being over than 40 minutes, development of cardiac complications or acute renal failure, and sepsis were found to be independent risk factors related with mortality. Conclusion: Our study results showed that preoperative hemodynamic regulation, shortening of aortic cross-clamp time and strict adherence to sterilization guidelines can reduce morbidity and mortality rates in cases with RAAA underwent repair surgery.
Amaç: Rüptüre abdominal aort anevrizması (RAAA) tanısı alarak açık cerrahi uygulanan hastalarda uyguladığımız tedavi yaklaşımlarının, karşılaşılan komplikasyonlar ve mortalite ile ilişkili risk faktörlerinin sunulmasıdır. Gereç ve Yöntem: Ekim 2010 ile Ağustos 2015 tarihleri arasında RAAA tanısı ile açık cerrahi uygulanan 39 hastanın verileri retrospektif olarak tarandı. Çalışma grubu ikiye ayrıldı; Grup-1 (n=14), cerrahi sonrası ilk 30 gün içerisinde kaybedilen olgulardan oluşurken, Grup-2 (n=25), halen hayatta olanlardan oluşmaktaydı. Mortalite ile ilişkili pre, intra ve postoperatif faktörler kaydedilerek istatistiksel olarak analiz edildi. Bulgular: Ortalama yaşı 68.9±9.5 yıl olan toplam 39 olgunun 37’si (%94.9) erkekti. Oniki hasta (%30.8) hipovolemik şokta iken ameliyata alındı. Tüm olguların %56.4’ünde anevrizma infrarenal yerleşimliydi. Takip döneminde, çalışma olgularının %69.2’sinde en az bir komplikasyon saptanırken, %38.5’inde iki veya daha fazla komplikasyon gözlendi. İki olgu (%5.1) intraoperatif olarak, 12 hasta (%30.8) ise operasyon sonrası ilk 30 gün içinde kaybedildi. İntraoperatif aortik kross-klemp süresi 40 dakikanın üzerinde olması, kardiyak komplikasyonların ya da akut renal yetmezliğin gelişmesi ve sepsis varlığı, mortalite ile ilgili bağımsız risk faktörleri olarak bulundu. Sonuç: Çalışmamızın sonuçları, preoperatif hemodinamik regulasyon, aortik kros-klemp süresinin kısaltılması ve sterilizasyon kılavuzlarına kesin uyum sağlanmasının tamir cerrahisi uygulanan RAAA hastalarında morbidite ve mortalite oranlarının düşürdüğünü göstermiştir.
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1. Kim IH, Kim DI, Huh SH, Lee SJ, Lee BB. Factors that affect the survival rate of ruptured abdominal aortic aneurysm. J Korean Soc Vasc Surg 2001;17(2):199-202.
2. Noel AA, Gloviczki P, Cherry KJ Jr, et al. Ruptured abdominal aortic aneurysms: The excessive mortality rate of conventional repair. J Vasc Surg 2001;34(1):41-6.
3. Davies RS, Dawlatly S, Clarkson JR, Bradbury AW, Adam DJ. Outcome in patients requiring renal replacement therapy after open surgical repair for ruptured abdominal aortic aneurysm. Vasc Endovascular Surg 2010;44(3):170-3.
4. Scarcello E, Ferrari M, Rossi G, et al. A new preoperative predictor of outcome in ruptured abdominal aortic aneurysms: the time before shock (TBS). Ann Vasc Surg 2010;24(3):315-20.
5. Halpern VJ, Kline RG, D’Angelo AJ, Cohen JR. Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms. J Vasc Surg 1997;26(6):939-45.
6. Leonard A, Thompson J. Anaesthesia for ruptured abdominal aortic aneurysm. Contin Educ Anaesth Crit Care Pain 2008;8(1):11-5.
7. Kauvar DS, Sarfati MR, Kraiss LW. Intraoperative blood product resuscitation and mortality in ruptured abdominal aortic aneurysm. J Vasc Surg 2012;55(3):688-92.
8. Cho MJ, Yoon HJ, Park JY, Huh S, Kim YW. The risk factors influencing postoperative mortality in the patients with ruptured abdominal aortic aneurysm. J Korean Soc Vasc Surg 2004;20(2):208-13.
9. Boyle JR, Gibbs PJ, King D, Shearman CP, Raptis S, Phillips MJ. Predicting outcome in ruptured abdominal aortic aneurysm: A prospective study of 100 consecutive cases. Eur J Vasc Endovasc Surg 2003;26(6):607-11.
10. Grant SW, Grayson AD, Grant MJ, Purkayastha D, McCollum CN. What are the risk factors for renal failure following open elective abdominal aortic aneurysm repair? Eur J Vasc Endovasc Surg 2012;43(2):182-7.
11. Kim SD, Hwang JK, Park SC, et al. Predictors of postoperative mortality of ruptured abdominal aortic aneurysm: A retrospective clinical study. Yonsei Med J 2012;53(4):772-80.
12. Mell MW, O’Neil AS, Callcut RA, et al. Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Surgery 2010;148(5):955-62.
13. Roberts K, Revell M, Youssef H, Bradbury AW, Adam DJ. Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2006;31(4):339-44.