Ruptured abdominal aortic aneurysms a study of prevalence, associated comorbidities, intervention techniques and mortality

Background:

Improving outcomes for patients with ruptured abdominal aortic aneurysms (rAAA) remains a challenging paradigm despite the utilisation of rapid emergency medical transport systems and the development of improved intraoperative anaesthetic and surgical techniques.

Objectives:

To analyse the incidence of rAAAs and to compare mortality associated with open versus endovascular repair.

Method:

A retrospective analysis of patients presenting with rAAAs between January 2010 and March 2018 was conducted using data from the Australasian Vascular Audit (AVA). Patients who did not undergo a procedure, had a suprarenal, mycotic or isolated iliac aneurysm, or had a previous repair were excluded.

Results:

52 patients were identified, of which 87% were male with a mean age of 78.3 years. There were 7 deaths of which 14% had IHD, 71% had hypertension, 57% were ex-smokers and no patients were recorded to have a history of diabetes. 19 patients (37%) underwent open repair, 31 (60%) successful endoluminal repair and 2 (4%) required conversion to open repair. Mortality was 26%, 13% and 100% respectively. The median (IQ range) diameter was 8.0 cm (6.0–9.0) and in the three groups 8.5 cm (7.3–9.0), 7.0 cm (6.0–8.0) and 9.0 cm (8.5–9.5) respectively. Seven rAAAs were less than 6 cm in diameter.

Conclusion:

Patients undergoing endoluminal repair for rAAA had significantly better survival than those undergoing open repair (P = 0.035). The mean diameter of rAAAs is higher than the threshold diameters usually suggested for elective repair. With rAAA still associated with a high morbidity and mortality, a protocol is being formulated at Royal North Shore Hospital to ensure expediated surgical intervention.