The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality. Significant mortality-related risk factor identification was the secondary endpoint. Open repair trend and its related perioperative mortality with a per-year analysis and a correlation subanalysis to identify predictive mortality factor were performed. Mean follow-up time was 23 (SD 23) months. Overall, 30-day mortality was 30%. Significant mortality-related risk factors were the use of computed tomography (CT) as a preoperative diagnostic tool, AAA rupture, preoperative shock, intraoperative cardiopulmonary resuscitation (CPR), use of aortic balloon occlusion, intraoperative massive blood transfusion (MBT), and development of abdominal compartment syndrome (ACS). Previous abdominal surgery was identified as a protective risk factor. The mortality rate at 90 days was 44%. Significant mortality-related risk factors were AAA rupture, aortocaval fistula, peripheral artery disease (PAD), preoperative shock, CPR, MBT, and ACS. The mortality rate at follow-up was 45%. Correlation analysis showed that MBT, shock, and ACS are the most relevant predictive mortality factor at 30 and 90 days. During the transition period from open to endovascular repair, open repair mortality outcomes remained comparable with other contemporary data despite a selection bias for higher risk patients. MBT, shock, and ACS are the most pronounced predictive mortality risk factors.
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
No funding were received for the study.
Conflict of interest
All authors declared that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Bown MJ, Sutton AJ, Bell PR, Sayers RD (2002) A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. Br J Surg 89(6):714–730CrossRefPubMedGoogle Scholar
Hallin A, Bergqvist D, Holmberg L (2001) Literature review of surgical management of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 22(3):197–204CrossRefPubMedGoogle Scholar
Lederle FA, Kane RL, MacDonald R, Wilt TJ (2007) Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med 146(10):735–741CrossRefPubMedGoogle Scholar
Veith FJ, Lachat M, Mayer D, Malina M, Holst J, Mehta M et al (2009) Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms. Ann Surg 250(5):818–824CrossRefPubMedGoogle Scholar
Lachat ML, Pfammatter T, Witzke HJ, Bettex D, Kunzli A, Wolfensberger U et al (2002) Endovascular repair with bifurcated stent-grafts under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Vasc Endovasc Surg 23(6):528–536CrossRefPubMedGoogle Scholar
Hechelhammer L, Lachat ML, Wildermuth S, Bettex D, Mayer D, Pfammatter T (2005) Midterm outcome of endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 41(5):752–757CrossRefPubMedGoogle Scholar
Malone DL, Hess JR, Fingerhut A (2006) Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma 60(6 Suppl):S91–S96CrossRefPubMedGoogle Scholar
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655CrossRefPubMedGoogle Scholar
Hickey GL, Dunning J, Seifert B, Sodeck G, Carr MJ, Burger HU et al (2015) Statistical and data reporting guidelines for the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery. Eur J Cardiothorac Surg 48(2):180–193CrossRefPubMedGoogle Scholar
Eliason JL, Wainess RM, Dimick JB, Cowan JA Jr, Henke PK, Stanley JC et al (2005) The effect of secondary operations on mortality following abdominal aortic aneurysm repair in the United States: 1988-2001. Vasc Endovasc Surg 39(6):465–472CrossRefGoogle Scholar
Visser P, Akkersdijk GJ, Blankensteijn JD (2005) In-hospital operative mortality of ruptured abdominal aortic aneurysm: a population-based analysis of 5593 patients in The Netherlands over a 10-year period. Eur J Vasc Endovasc Surg 30(4):359–364CrossRefPubMedGoogle Scholar
Dueck AD, Kucey DS, Johnston KW, Alter D, Laupacis A (2004) Survival after ruptured abdominal aortic aneurysm: effect of patient, surgeon, and hospital factors. J Vasc Surg 39(6):1253–1260CrossRefPubMedGoogle Scholar
Sasaki Y, Isobe F, Kinugasa S, Iwata K, Murakami T, Saito M et al (2004) Influence of coronary artery disease on operative mortality and long-term survival after abdominal aortic aneurysm repair. Surg Today 34(4):313–317CrossRefPubMedGoogle Scholar
Halpern VJ, Kline RG, D’Angelo AJ, Cohen JR (1997) Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms. J Vasc Surg 26(6):939–945 (discussion 45–8)CrossRefPubMedGoogle Scholar
Alonso-Perez M, Segura RJ, Sanchez J, Sicard G, Barreiro A, Garcia M et al (2001) Factors increasing the mortality rate for patients with ruptured abdominal aortic aneurysms. Ann Vasc Surg 15(6):601–607CrossRefPubMedGoogle Scholar
Blaisdell FW (2002) The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg 10(6):620–630CrossRefPubMedGoogle Scholar
Rasmussen TE, Hallett JW Jr, Noel AA, Jenkins G, Bower TC, Cherry KJ Jr et al (2002) Early abdominal closure with mesh reduces multiple organ failure after ruptured abdominal aortic aneurysm repair: guidelines from a 10-year case-control study. J Vasc Surg 35(2):246–253CrossRefPubMedGoogle Scholar
Mani K, Lees T, Beiles B, Jensen LP, Venermo M, Simo G, et al (2011) Treatment of abdominal aortic aneurysm in nine countries 2005–2009: a vascunet report. Eur J Vasc Endovasc Surg 42(5):598–607Google Scholar
Noel AA, Gloviczki P, Cherry KJ Jr, Bower TC, Panneton JM, Mozes GI et al (2001) Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair. J Vasc Surg 34(1):41–46CrossRefPubMedGoogle Scholar
Wahlberg E, Dimuzio PJ, Stoney RJ (2002) Aortic clamping during elective operations for infrarenal disease: the influence of clamping time on renal function. J Vasc Surg 36(1):13–18CrossRefPubMedGoogle Scholar
Kudo FA, Nishibe T, Miyazaki K, Murashita T, Yasuda K, Ando M et al (2004) Postoperative renal function after elective abdominal aortic aneurysm repair requiring suprarenal aortic cross-clamping. Surg Today 34(12):1010–1013CrossRefPubMedGoogle Scholar
Sasaki S, Sakuma M, Samejima M, Kunihara T, Shiiya N, Murashita T et al (1999) Ruptured abdominal aortic aneurysms: analysis of factors influencing surgical results in 184 patients. J Cardiovasc Surg (Torino) 40(3):401–405Google Scholar
Bajardi G, Pecoraro F, Mirabella D, Bracale UM, Bellisi MG (2009) Abdominal compartment syndrome (ACS) after abdominal aortic aneurysm (AAA) open repair. Ann Ital Chir 80(5):369–374PubMedGoogle Scholar
Biancari F, Mazziotti MA, Paone R, Laukontaus S, Venermo M, Lepantalo M (2011) Outcome after open repair of ruptured abdominal aortic aneurysm in patients >80 years old: a systematic review and meta-analysis. World J Surg 35(7):1662–1670CrossRefPubMedGoogle Scholar
Holt PJ, Karthikesalingam A, Poloniecki JD, Hinchliffe RJ, Loftus IM, Thompson MM (2010) Propensity scored analysis of outcomes after ruptured abdominal aortic aneurysm. Br J Surg 97(4):496–503CrossRefPubMedGoogle Scholar
Karkos CD, Sutton AJ, Bown MJ, Sayers RD (2011) A meta-analysis and metaregression analysis of factors influencing mortality after endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 42(6):775–786CrossRefPubMedGoogle Scholar
Takagi H, Umemoto T (2011) A meta-analysis of randomized and risk-adjusted observational studies of endovascular versus open repair for ruptured abdominal aortic aneurysm. Vasc Endovasc Surg 45(8):717–719CrossRefGoogle Scholar
Veith FJ, Cayne NS, Berland TL, Mayer D, Lachat M (2012) Current role for endovascular treatment of ruptured abdominal aortic aneurysms. Semin Vasc Surg 25(3):174–176CrossRefPubMedGoogle Scholar
Lachat ML, Pecoraro F, Mayer D, Guillet C, Glenck M, Rancic Z et al (2013) Outpatient endovascular aortic aneurysm repair: experience in 100 consecutive patients. Ann Surg 258(5):754–758 (discussion 8–9)CrossRefPubMedGoogle Scholar