Outcomes of surgical management of ruptured abdominal aortic aneurysm

Background Ruptured abdominal aortic aneurysms have remained a challenge to the cardiovascular surgeon. They are rapidly fatal if left untreated with reported mortality rates approaching 50%. Urgent surgery is the accepted modality of therapy. We report the outcome of surgical management of this subset of patients. Methods We retrospectively analyzed case records of 36 consecutive patients who underwent surgery for ruptured infra-renal abdominal aortic aneurysm (RAAA) at our institute between January 1990 and January 2005. Thoraco-abdominal & iliac aneurysms were excluded from the study. Mean age was 59 years±14.3 (Range—20 to 81 years). 33 of the patients were operated as an emergency. Systemic hypertension, renal dysfunction and coronary artery disease were the major co-morbid conditions. Results Hospital mortality was 42% (15/36 patients). 6 patients died of diffuse bleeding and coagulopathy, 5 patients had peri-operative myocardial infarction, 2 patients developed acute renal failure, and 1 each died of large bowel gangrene and massive haemoptysis. Follow up ranged from 2 to 9 years with a mean of 4.3 years. There were no major morbidities at mid-term follow-up. Conclusion Emergency surgery for RAAA continues to be associated with a high mortality rate, despite the improvements in surgical techniques and post-operative care. Early detection and subsequent treatment would circumvent the high mortality associated with these patients.