Emergency Abdominal Aortic Aneurysm Repair: Factors Affecting Survival and Long-Term Results

Elective surgery for abdominal aortic aneurysm (AAA) has become a safe operation, although the mortality related to ruptured AAA remains considerably high. Factors affecting survival of 32 consecutive patients with ruptured AAAs were evaluated. The postoperative mortality was 50% (16/32) compared with 1.9% for 103 elective AAA patients. Factors associated with poor prognosis were systolic blood pressure of less than 90 mmHg and severe metabolic acidosis on arrival to the hospital, size of the aneurysm, and massive blood transfusion. The high mortality and morbidity rates of the ruptured AAA patients emphasize the need for early and aggressive treatment of AAA in the elective setting in the patient at high risk. In follow-up study, however, the actuarial survival following ruptured AAA surgery, excluding hospital mortality, was 77% at five years. It did not differ statistically from that of patients who had elective AAA surgery. The quality of life survey following surgery showed no discernible differences between ruptured and elective AAA surgery.