ADVANCES IN THE SURGICAL REPAIR OF RUPTURED ABDOMINAL AORTIC ANEURYSM

R. Clement Darling III, Md, Juan A. Cordero, Jr., Md, Benjamin B. Chang, Md, Dhiraj M. Shah, Md, Philip S.K. Paty, Md, William E. Lloyd, Md, Robert P. Leather, Md
Vascular Surgery Section, Albany Medical College,
Albany, NY, USA

Over the past two decades, mortality/or elective repair ofinfrarenal abdominal aortic aneurysms (AAA) has improved to an acceptable level (<5%). However, surgical results of ruptured abdominal dortik aneurysms (RAAA) have remained fairly constant with about 50% in hospital mortality rates. Growing experience with the use of the left retroperitoneal exposure for elective aortic surgery allowed us to extend the use of this technique to the repair of RAAA. The extended left retroperitoneal approach using a postero-lateral exposure through the 10th intercostal space allowed the surgeon to expeditiously and reliably obtain supraceliac aortic control by dividing the left crus of the diaphragm in all patients performed 104 aortic replacements for RAAA during the past seven years. There were 87 men and 17 women with a mean age of 72 years (range: 52-95). Hemodynamic instability as defined by a systolic blood pressure of less than 90 mm Hg was present preoperatively in 41% (43/104) of patients. Operative mortality was 27.9% (29/104). Pre-operative hemodynamic instability, time of operative delay and aortic cross clamp time had no correlation with operative mortality. Median duration of intensive care unitsfay was four days (range: 1-60) and hospital stay was eleven days (range: 6-175). The results of this series identified that a change in the operative technique for the repair of RAAA beneficially affected patient survival. We suggest that expeditious supraceliac control without tho-racotomy is an excellent alternative and offers an advantage in the surgical management of RAAA.

P. 30

« Back