Pathophysiology and Problems of the Surgical Treatment in Acutely Ruptured Abdominal Aortic Aneurysm

Twenty cases of acute ruptured abdominal aortic aneurysm were compared with 82 cases of non-ruptured cases and 2 cases of chronic ruptured abdominal aortic aneurysm undergoing elective surgery for the sex, age at operation, maximal diameter of the aneurysm, operative blood loss, blood infusion volume, and urinary volume. Furthemore, acute ruptured cases were divided into 10 cases saved successfully, 5 cases of table death, and another 5 cases of postoperative death due to multiple organ failure, and those patient groups were compared for clinical symptoms and operative procedures. Ruptured cases had a large diameter of the aneurysm, longer operation time, more blood loss, and more infusion volume than non-ruptured cases. Prognoses of ruptured patients were very poor, especially for those whose blood pressure on induction of the anesthesia was under 60 mmHg, or who had oliguria, suprarenal typed aneurysm which needed a cross clamp above the renal arteries. We should have made anatomical bypasses for patients who had colon necrosis and aortoduodenal fistula using gelatin-coated dacron grafts based in rifampicin and the septation from intestinal lesions with the greater omentum. Otherwise, we should have made extra-anatomical bypasses as axillo-bifemoral bypasses. In the case of aorto-caval fistula, the importance of early detection is emphasized.