Preoperative predictors of mortality risk in ruptured abdominal aortic aneurysm

Shackleton, Christopher R.; Schechter, Martin T.; Bianco, Rodolfo; Hildebrand, Henry D.

doi:10.1067/mva.1987.avs0060583

Cited by 14 publications

(8 citation statements)

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“…As a result, most of the recent literature on ruptured AAAs has focused on selecting patients who are likely to survive, and some authors have advocated abandoning treatment for certain groups of patients who have risk factors that predict a poor outcome. 5,6,8,9,11,15,16,19,20,22 In addition, it has been thought that further improvement in surgical outcome is unlikely; therefore, the focus has shifted toward screening patients to treat aneurysms before they rupture. 3,8,12,18 -20 We believe the reason why the outcome after surgical repair of ruptured aortoiliac aneurysms (AIAs) has not improved relates to the fact that the basic surgical techniques for repairing ruptured AIAs remain little changed in the past four decades, although several improvements have been introduced.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Grafts and Other Image-Guided Catheter-Based Adjuncts to Improve the Treatment of Ruptured Aortoiliac Aneurysms

Ohki¹,

Veith²

2000

Annals of Surgery

170

142

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ObjectiveTo report a new management approach for the treatment of ruptured aortoiliac aneurysms. MethodsThis approach includes hypotensive hemostasis, minimizing fluid resuscitation, and allowing the systolic blood pressure to fall to 50 mmHg. Under local anesthesia, a transbrachial guidewire was placed under fluoroscopic control in the supraceliac aorta. A 40-mm balloon catheter was inserted over this guidewire and inflated only if the blood pressure was less than 50 mmHg, before or after the induction of anesthesia. Fluoroscopic angiography was used to determine the suitability for endovascular graft repair. When possible, a prepared, "one-size-fits-most" endovascular aortounifemoral stented PTFE graft was used, combined with occlusion of the contralateral common iliac artery and femorofemoral bypass. If the patient's anatomy was unsuitable for endovascular graft repair, standard open repair was performed using proximal balloon control as needed. ResultsTwenty-five patients with ruptured aortoiliac aneurysms (18 aortic, 7 iliac) were managed using this approach. Balloon inflation for proximal control was required in nine of the 25 patients. Twenty patients were treated with endovascular grafts. Five patients required open repair. The ruptured aneurysm was excluded in all 25 patients; 23 survived. Two deaths occurred in patients who received endovascular grafts with serious comorbidities. The surviving patients who received endovascular grafts had a median hospital stay of 6 days, and the preoperative symptoms resolved in all patients. ConclusionsHypotensive hemostasis is usually an effective means to provide time for balloon placement and often for endovascular graft insertion. With appropriate preparation and planning, many if not most patients with ruptured aneurysms can be treated by endovascular grafts. Proximal balloon control is not required often but may, when needed, be an invaluable adjunct to both endovascular graft and open repairs. The use of endovascular grafts and this approach using other imageguided catheter-based adjuncts appear to improve treatment outcomes for patients with ruptured aortoiliac aneurysms.Four decades have passed since the first surgical repair of a ruptured infrarenal abdominal aortic aneurysm (AAA) was reported by Gerbode in 1954.1 During this period, several important advances have been made in the nonsurgical aspects of care. These include improvements in the transportation of these patients, critical care, and management of cardiac dysfunction and pharmacologic support. Despite these efforts, surgical death rates have not improved significantly and still range from 24% to 70%. As a result, most of the recent literature on ruptured AAAs has focused on selecting patients who are likely to survive, and some authors have advocated abandoning treatment for certain groups of patients who have risk factors that predict a poor outcome.

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Section: Discussionmentioning

confidence: 99%

Endovascular Grafts and Other Image-Guided Catheter-Based Adjuncts to Improve the Treatment of Ruptured Aortoiliac Aneurysms

Ohki¹,

Veith²

2000

Annals of Surgery

170

142

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“…All patients with the diagnosis of abdominal aortic aneurysm who reached the operating theatre alive were studied. A literature search was performed and papers containing information on the survival of patients who had undergone abdominal aortic aneurysm repair were reviewed [1][2][3][4][5][6]. Factors which may be linked with prognosis were identified.…”

Section: Methodsmentioning

confidence: 99%

“…As these patients have poor physiological reserve, morbidity is high and survival poor. Reported mortality figures following emergency repair vary between 30 and 70% [1][2][3][4][5][6], while those for elective repair are lower at 1.4-6% [1,7,8]. Furthermore, abdominal aortic aneurysms are common, with an incidence of 17-64 per 100 000 of the population in the UK [9,10], and so emergency repair of abdominal aortic aneurysm represents a significant workload for vascular surgery and critical care services.…”

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confidence: 99%

Prognostic indicators following emergency aortic aneurysm repair

Urwin¹,

Ridley²

1999

Anaesthesia

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SummaryWe performed a retrospective study of 135 patients presenting for emergency abdominal aneurysm repair to determine predictive factors for outcome. The outcome measures investigated were mortality in the operating theatre and intensive care, and at 28 and 100 days. Univariate analysis showed that the patient's age, hypotension on admission, aneurysmal rupture, pre-operative cardiopulmonary resuscitation, intra-operative blood loss and hypotension were risk factors for death either in the operating theatre or up to 100 days after surgery. Binary logistic regression identified the independent risk factors for survival. Operative survival was determined by acute factors such as pre-operative cardiopulmonary resuscitation, aneurysmal rupture and intra-operative hypotension. Longer term survival was determined by the patient's age, aneurysmal rupture, blood loss and blood pressure at admission. Using a binary logistic regression equation, from which a simplified risk score was derived, it is possible to predict the likelihood of survival of individual patients presenting for abdominal aortic aneurysm repair.

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“…In fact, as early as 1987, Shackleton et al (14) noted that an elevation of the unmeasured anion gap was significantly and independently associated with mortality for ruptured AAA patients. Grist and Thomas (28) reported that anion gap is a risk factor in long-term extracorporeal support.…”

Section: Discussionmentioning

confidence: 99%

“…Given the high total mortality estimated at 80–100% for ruptured AA (8,9), the best way to reduce the overall mortality of the disease may be to detect and treat it prior to rupture. In fact, many predictors or predictive models of mortality risk in AA patients have been reported (10–14), but further validation is required. Herein, we focused on AA patients in intensive care unit (ICU) and investigated the predictive value of serum anion gap on ICU mortality, a routine clinical indicator which has been reported to be associated with mortality of several diseases (15–18).…”

Section: Introductionmentioning

confidence: 99%

Serum anion gap on admission predicts intensive care unit mortality in patients with aortic aneurysm

Chen

et al. 2018

Exp Ther Med

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It has been widely reported that the serum anion gap is significantly associated with mortality in intensive care unit (ICU); however, it remains unknown whether the association is present in aortic aneurysm (AA) patients. The present study aimed to investigate the association between the admission serum anion gap and ICU mortality in AA patients. Data extracted from a publicly accessible clinical database using a modifiable data mining technique were analyzed retrospectively, mainly by employing multivariable logistic regression analysis. The primary study outcome was ICU mortality. A total of 273 patient records were analyzed. The ICU mortality was 8.79% (24/273). The median serum anion gap was significantly higher in non-survivors [17.50 mEq/l, interquartile range (IQR) 15.75–22.50 mEq/l] compared with survivors [13.00 mEq/l, IQR 11.00–15.00 mEq/l, P<0.001]. Multivariate analysis resulted in identification of a clear association between admission serum anion gap and ICU mortality in AA patients [odds ratio (OR) 1.38 per 1 mEq/l increase, 95% confidence interval (CI) 1.08–1.76]. The area under the receiver operating characteristic curve showed an outstanding discrimination ability in predicting ICU mortality (area under curve 0.8513, 95% CI 0.7698–0.9328). In conclusion, admission serum anion gap may serve as a strong predictor of ICU mortality for AA patients.

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Preoperative predictors of mortality risk in ruptured abdominal aortic aneurysm

Cited by 14 publications

References 0 publications

Endovascular Grafts and Other Image-Guided Catheter-Based Adjuncts to Improve the Treatment of Ruptured Aortoiliac Aneurysms

Endovascular Grafts and Other Image-Guided Catheter-Based Adjuncts to Improve the Treatment of Ruptured Aortoiliac Aneurysms

Prognostic indicators following emergency aortic aneurysm repair

Serum anion gap on admission predicts intensive care unit mortality in patients with aortic aneurysm

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