To identify the factors affecting the high mortality rates associated with ruptured abdominal aortic aneurysm (AAA), a review was made of the records of 81 patients treated surgically between 1972 and 1983. Correlation of data with survival and predictive value of preoperative findings were studied. The mortality rate was 43.2%; there was a 29.2% mortality rate among those surviving the day of surgery. Patient-determined variables associated with deaths included age more than 76 years, hematocrit less than 30% and acute abnormality detected by ECG at admission, and suprarenal extension or free rupture of the AAA. Survival could be predicted with only 70% accuracy with a computerized discriminant function based on age and hematocrit and blood pressure values determined at admission. Events following admission associated with death were precipitous fall or persistently low level of preoperative blood pressure, technical complications, and postoperative organ failure. Although the patient's ultimate outcome after ruptured AAA is partly determined before intervention of the physician, efforts to address events resulting in death after admission by improving rapid diagnosis, early resuscitation, and prompt flawless surgery can increase survival.

No abstract

To identify the factors affecting the high mortality rates associated with ruptured abdominal aortic aneurysm (AAA), a review was made of the records of 81 patients treated surgically between 1972 and 1983. Correlation of data with survival and predictive value of preoperative findings were studied. The mortality rate was 43.2%; there was a 29.2% mortality rate among those surviving the day of surgery. Patient-determined variables associated with deaths included age more than 76 years, hematocrit less than 30% and acute abnormality detected by ECG at admission, and suprarenal extension or free rupture of the AAA. Survival could be predicted with only 70% accuracy with a computerized discriminant function based on age and hematocrit and blood pressure values determined at admission. Events following admission associated with death were precipitous fall or persistently low level of preoperative blood pressure, technical complications, and postoperative organ failure. Although the patient's ultimate outcome after ruptured AAA is partly determined before intervention of the physician, efforts to address events resulting in death after admission by improving rapid diagnosis, early resuscitation, and prompt flawless surgery can increase survival.

Axillofemoral bypass (AXB) was performed on 100 patients who had claudication (19), pain at rest (42), gangrene or ulcer (22), aortic sepsis (14), or unresectable abdominal aneurysm (3). Unilateral (27 grafts), double unilateral (1), or axillobifemoral (72) grafts with Dacron (58), polytetrafluoroethylene (PTFE) (28), ring-supported Dacron or PTFE (12), or other material (2) were performed by 13 surgeons. Eight patients died within 30 days and three major amputations were necessary. Fifty-two (57%) of the 92 survivors had a total of 92 graft complications during a mean follow-up period of 21.5 months. Thirty-two patients underwent 57 reoperations of various types, incurring an additional three deaths and three amputations. Sixty (65%) of the original 92 survivors of AXB avoided reoperation. The 89 patients who survived the original and repeat procedures were followed up through the end of 1984 (62 patients), to late death (23), or to late graft removal (4), whichever occurred first. At these end points, 83 of the 89 (93%) patients had patent grafts. The graft patency rate of the original 100 AXBs by life table was 54% at 36 months; but with reoperation, it was 72%. Among those patients who left the hospital after AXB, the survival rate at 36 months was 69%. Statistically insignificant trends toward improved early patency were noted with bilateral femoral anastomoses, total iliac occlusion, and less severe ischemia. AXB provided safe palliation of severe arterial disease, with overall graft patency exceeding postoperative patient survival according to life-table analysis. However, the safety of AXB was tempered by frequent complications and the necessity for many reoperations to provide maximum efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)