Rüptüre aort anevrizma tamiri cerrahisi sonrası gelişen major komplikasyonların mortalite üzerine etkisi

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.

Impacts of major complications seen after ruptured abdominal aortic aneurysm repair surgery over mortality

Aim: To present our management approach, complications, and mortality-related risk factors in patients diagnosedwith ruptured abdominal aortic aneurysm (RAAA) who underwent open surgery.Materials and Methods: The charts of 39 patients with RAAA who underwent open surgery between September2010 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 withhypovolemic 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 morecomplications. Two patients (5.1%) died in the intraoperative period, whereas 12 (30.8%) died within 30 days afterthe operation. Intraoperative aortic cross-clamp time being over than 40 minutes, development of cardiaccomplications 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-clamptime and strict adherence to sterilization guidelines can reduce morbidity and mortality rates in cases with RAAAunderwent repair surgery.

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