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Vol 8, No 4 (2002)
Research paper
Published online: 2002-10-21

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Are we supposed to operate every ruptured aneurysm of the abdominal aorta?

Wojciech Witkiewicz, Krzysztof Czarnecki, Mariusz Maszkowski
Acta Angiologica 2002;8(4):127-136.


Background. An attempt to answer the question if it is rational to operate every patient with a ruptured abdominal aorta aneurysm (rAAA) is undertaken in this paper by a retrospective evaluation of the significant factors which strongly influence the fatal outcome of surgical treatment.
Material and methods. The medical files were analysed of 142 patients operated on for rAAA between 1984 and 2000 in the County Hospital of Wrocław, General and Vascular Surgery Department. Forty-one risk factors were evaluated of patients with rAAA on admission to the hospital, during the operation and after the operation. The special mathematical and statistical tool SYNTMED® was used for the evaluation. According to that evaluation the risk of fatal outcome was assessed for each analysed patient and expressed by a value between 0 and 1 (coefficient Z). The higher the value of Z, the poorer the outcome noticed. The system allowed us also to evaluate each analysed risk factor and to express it with the coefficient Z value.
Results. Fatal outcome was noticed in 92 patients (64%). Intraoperatively 24 (16%) patients died, including 12 (8%) before using vascular prosthesis. During the first two days 55 (39%) patients died. All patients with coefficient Z value below 0.3 survived the operation. No-one survived from the group with coefficient Z value above 0.79. The average coefficient Z value of patients who survived the operation was 0.41 and was significantly lower than the average coefficient Z value (0.58) of patients who died (P < 0.05). The most important factors which present the higher Z value and have a strong inverse influence on the treatment result of rAAA were: 1. Among preoperative factors - hypercapnia, acidosis, low systolic blood pressure, congestive heart failure, hypoxia. 2. Among intraoperative factors - episodes of low blood pressure, high blood loss, implantation of bifurcated graft. 3. Among postoperative factors - cardiological complications, renal failure, haemorrhagic complications.
Conclusions. The authors suggest that medical experience and treatment results justify abandoning surgical treatment of rAAA patients after cardiac arrest or with developed irreversible haemorrhagic shock on admission to the hospital, but ethical and legal aspects do not allow that.

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