|Surgical Treatment for Ruptured
(Department of Cardiovascular Surgery, Takeda Hospital,
|Elective resection of abdominal
aortic aneurysms is now a safe operation, but mortality related
to ruptured abdominal aortic aneurysm (rAAA) remains high. In
many reports, there has been much discussion about the factors
that affect the mortality rate of patients who had rAAA repair.
Preoperative shock is the most frequently cited prognostic factor
related to survival. At the induction of anesthesia in these
patients it is not rare for hypotension to cause deep shock.
To prevent these deep shock states, we make a mid-abdominal skin
incision simultaneously at the induction of general anesthesia
just after preparation. Forty-four cases of rAAA underwent emergency
surgery with this technique between April 1993 and December 1999.
We also reviewed medical records of these 44 consecutive patients
to evaluate clinical factors in mortality after rAAA resection.
The overall hospital mortality rate was 18.2% (8/44) in our series.
Factors associated with poor prognosis were the duration of preoperative
shock state (P＝0.031), an episode of cardiac arrest (P＝0.015),
an episode of loss of consciousness (P＝0.018), systolic
blood pressure of less than 60mmHg at the induction of anesthesia
(P＝0.019), intraperitoneal rupture (P＝0.010) and
intraoperative massive blood transfusion (P＝0.043). These
findings suggest that these factors may be reflections of preoperative
shock and intraoperative technical errors. The surgical results
of rAAA have improved significantly due to the prevention of
hypotension which may cause a state of deep shock at induction
of anesthesia. Although the patient's outcome after rupture of
AAA is partly determined before intervention by the surgeon,
efforts for rapid diagnosis and prompt flawless surgery can increase
Jpn. J. Cardiovasc. Surg. 31：258-261 (2002)