Ruptured abdominal aortic aneurysms (AAAs) have a high mortality. There have been few trials that examine the role of blood pressure management strategies prior to surgical repair of ruptured AAAs. Retrospective analyses have shown an association between higher volumes of crystalloid and colloid administration and mortality while controlling for key confounders. Permissive hypotension is a strategy used in trauma to avoid clot disruption, coagulopathy, hypothermia, and acidosis. International consensus guidelines recommend the use of permissive hypotension during the acute resuscitation of a patient with ruptured AAA, delaying aggressive fluid resuscitation until after surgical repair. A recommended approach for ruptured AAA management is (1) judicious fluid resuscitation targeting systolic blood pressure of 70–100 mmHg, (2) monitoring for impaired end-organ perfusion, and (3) emergent surgical intervention.
Ruptured abdominal aortic aneurysm Damage control resuscitation Permissive hypotension
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Moreno DH, Cacione DG, Baptista-Silva JCC. Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev. 2016;2016(5):1–16.Google Scholar
Kurc E, Sanioglu S, Ozgen A, Aka SA, Yekeler I. Preoperative risk factors for in-hospital mortality and validity of the Glasgow aneurysm score and Hardman index in patients with ruptured abdominal aortic aneurysm. Vascular. 2012 Jun;20(3):150–5.CrossRefGoogle Scholar
Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41(Suppl 1):S1–S58.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Hardman DTA, Fisher CM, Patel MI, Neale M, Chambers J, Lane R, et al. Ruptured abdominal aortic aneurysms: who should be offered surgery? J Vasc Surg. 1996;23(1):123–9.CrossRefGoogle Scholar
Dick F, Erdoes G, Opfermann P, Eberle B, Schmidli J, von Allmen RS. Delayed volume resuscitation during initial management of ruptured abdominal aortic aneurysm. J Vasc Surg. 2013;57(4):943–50.CrossRefGoogle Scholar
van der Vliet JA, van Aalst DL, Schultze Kool LJ, Wever JJ, Blankensteijn JD. Hypotensive hemostatis (permissive hypotension) for ruptured abdominal aortic aneurysm: are we really in control? Vascular. 2007 Jul;15(4):197–200.CrossRefGoogle Scholar
Park BD, Azefor N, Huang C-C, Ricotta JJ. Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care. J Am Coll Surg. 2013;216(4):745–54.CrossRefGoogle Scholar
Hamilton H, Constantinou J, Ivancev K. The role of permissive hypotension in the management of ruptured abdominal aortic aneurysms. J Cardiovasc Surg. 2014 Apr;55(2):151–9.Google Scholar
Tadlock MD, Sise MJ, Riccoboni ST, Sise CB, Sack DI, Sise RG, et al. Damage control in the management of ruptured abdominal aortic aneurysm: preliminary results. Vasc Endovasc Surg. 2010;44(8):638–44.CrossRefGoogle Scholar
Powell JT. Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. Br J Surg. 2014;101(3):216–24.CrossRefGoogle Scholar