Ruptured Abdominal Aortic Aneurysms: Selecting Patients for Surgery

Prance, Sarah; Wilson, Y.G.; Cosgrove, C.; Walker, A. J.; Wilkins, David G.; Ashley, S.

doi:10.1053/ejvs.1998.0718

Cited by 58 publications

(42 citation statements)

References 9 publications

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“…Of the 10 patients that scored 3 or more on the Hardman Index, three (30%) survived surgery despite suggestions in the literature that this cut-off value is almost universally fatal. 18 Six (26%) of the 23 patients that scored more than 95 on the Glasgow Aneurysm Score had the same favourable result. Whilst the potential of such statistical models to predict outcomes may seem appealing, our results suggest otherwise.…”

Section: Table 3 Basic Characteristics Of the Different Patient Cohortsmentioning

confidence: 89%

“…An Hardman Index equal to or greater than 3 was considered to indicate a patient at high risk of surgical mortality since this has been reported to be almost universally fatal. 18 The Glasgow Aneurysm Score was also calculated from five pre-operative variables (Table 2). Points were awarded for age, shock, myocardial disease, cerebrovascular disease and renal impairment using the formula: Glasgow Aneurysm Score = age (in years) + 17 for shock + 7 for myocardial disease + 10 for cerebrovascular disease + 14 for renal disease.…”

Section: Methodsmentioning

confidence: 99%

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Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

Gatt

Goldsmith

Martinez

et al. 2009

annals

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INTRODUCTION The aim of this study was to assess the value of the Hardman Index and the Glasgow Aneurysm Score in predicting postoperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA), and to assess the correlation between the two. PATIENTS AND METHODS Patients admitted with rAAA were identified from a hospital database. Hospital records were reviewed and a retrospective Hardman Index and Glasgow Aneurysm Score was calculated. Poor postoperative prognosis was considered at a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3. RESULTS A total of 96 patients with a median age of 77.5 years (interquartile range, 71-83 years) and a male:female ratio of 2:1 were identified. Of these, 37 patients were not offered surgery and this was associated with 100% mortality. Of the 59 operated patients, 36 (61%) patients died postoperatively. Operated patients had a median Glasgow Aneurysm Score of 91 (interquartile range, 77-101) and a Hardman Index of 2 (interquartile range, 1-2). In this group, a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3 was not associated with mortality (P = 0.10 and P = 0.79, respectively). Correlation between the scoring systems was poor (+0.42 τ b ). CONCLUSIONS The scoring systems assessed did not help predict the outcome of rAAA surgery, and correlated poorly with each other. They do not aid clinical judgement. GATT GOLDSMITH MARTINEZ et al.

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Section: Table 3 Basic Characteristics Of the Different Patient Cohortsmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

Gatt

Goldsmith

Martinez

et al. 2009

annals

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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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“…A patient with RAAA may score between 0 (no positive risk factors) and 5 (five positive factors). It has been suggested in other studies that a patient with three or more of these risk factors is unlikely to survive operation 12 .…”

Section: Hardman Indexmentioning

confidence: 99%

Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm

Neary

Crow

Foy

et al. 2003

British Journal of Surgery

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Ruptured Abdominal Aortic Aneurysms: Selecting Patients for Surgery

Abstract: These results lend support to the validity of the model. The potential to avoid surgery in patients with little or no chance of survival would spare unnecessary suffering, reduce operative mortality and enhance use of scarce resources.

Cited by 58 publications

References 9 publications

Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?

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

Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm

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