THE IMPACT OF PERIOPERATIVE FACTORS ON THE OUTCOME IN PATIENTS WITH RUPTURED ABDOMINAL AORTIC ANEURYSM
Abstract
Introduction: An aneurysm is a permanent, localized extension of an artery diameter by at least 50% relative to its physiological diameter. Its most common localization is on the abdominal aorta. Rupture, the most common complication of an aneurysm, is clinically significant because of the high mortality rate. Patients with ruptured aneurysm of the abdominal aorta undergo urgent surgical treatment, where despite the efforts of surgeons and expansive progress in both medicine and technology, intraoperative and postoperative mortality is still present in a high percentage.
The Aim: To examine how different perioperative factors affect the outcome in patients with ruptured aneurysms of the abdominal aorta.
Material and methods: A retrospective study based on medical records for a two-year period, in which descriptive statistical methods processed and analyzed perioperative clinical parameters and their impact on outcome in 57 patients operated on for rupture of abdominal aortic aneurysm.
Results: Preoperative values of hemoglobin and components of the hemostasis system, intraoperative blood replenishment and intraoperative pH, and postoperative values of potassium, lactate, and the amount of diuresis in the first 24 hours after surgery showed a statistically significant effect on the outcome in patients operated at the Clinical Center of Vojvodina due to rupture of abdominal aortic aneurysm.
Conclusion: The operative outcome in rAAA is still unpredictable despite many years of research into perioperative factors and attempts to find an ideal scoring system.
References
Cronenwett JL, Johnston KW. Rutherford's vascular surgery. 8th ed. Philadelphia: Elsevier Health Sciences; 2014.
Davidovic L. Aortic surgery. Belgrade: Institute for Textbooks; 2015.
Jang HN, Park HO, Yang JH, Yang TW, Byun JH, Moon SH, et al. Evaluation of preoperative predictors of 30-day mortality in patients with ruptured abdominal aortic aneurysm. Vasc Specialist Int. 2017 Sep; 33(3):93-8. doi: 10.5758/vsi.2017.33.3.93.
Neary WD, Crow P, Foy C, Prytherch D, Heather BP, Earnshaw JJ. Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm. Br J Surg. 2003 Apr; 90(4):421-5. doi: 10.1002/bjs.4061.
Patterson BO, Holt PJ, Hinchliffe R, Loftus IM, Thompson MM. Predicting risk in elective abdominal aortic aneurysm repair: a systematic review of current evidence. Eur J Vasc Endovasc Surg. 2008 Dec; 36(6):637-45. doi: 10.1016/j.aves.2008.08.016.
Vos CG, de Vries JP, Werson DA, van Dongen EP, Schreve MA, Ünlü Ç. Evaluation of five different aneurysm scoring systems to predict mortality in ruptured abdominal aortic aneurysm patients. J Vasc Surg. 2016 Dec; 64(6):1609-16. doi: 10.1016/j.jvs.2016.05.099.
van Beek SC, Reimerink JJ, Vahl AC, Wisselink W, Peters RJ, Legemate DA, et al. Amsterdam Acute Aneurysm Trial Collaborators. Editor's choice--External validation of models predicting survival after ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2015 Jan; 49(1):10-6. doi: 10.1016/j.aves.2014.10.012.
von Meijenfeldt GC, van Beek SC, Bastos Gonçalves F, Verhagen HJ, Zeebregts CJ, Vahl AC, et al. Development and external validation of a model predicting death after surgery in patients with a ruptured abdominal aortic aneurysm: the Dutch Aneurysm Score. Eur J Vasc Endovasc Surg. 2017 Feb; 53(2):168-74. doi: 10.1016/j.aves.2016.10.024.
Antonello M, Lepidi S, Kechagias A, Frigatti P, Tripepi A, Biancari F, et al. Glasgow Aneurysm Score predicts the outcome after emergency open repair of symptomatic, unruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2007 Mar; 33(3):272-6. doi: 10.1016/j.aves.2006.09.006.
Marković M, Davidović L, Maksimović Ž, Kostić D, Pejkić S, Kuzmanović I, et al. The influence of intraoperative parameters on the survival of patients with rupture of abdominal aortic aneurysms. Srp Arh Celok Lek. 2004 Jan-Feb; 132(1-2):5-9. English. doi: 10.2298/sarh0402005m.
Laukontaus SJ, Lepäntalo M, Hynninen M, Kantonen I, Pettilä V. Prediction of survival after 48-h of intensive care following open surgical repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2005 Nov; 30(5):509-15. doi: 10.1016/j.aves.2005.06.013
Neilson M, Healey C, Clark D, Nolan B. External validation of a rapid ruptured abdominal aortic aneurysm score. Ann Vasc Surg. 2018 Jan;46:162-67. doi: 10.1016/j.avsg.2017.08.016.
Kniemeyer HW, Kessler T, Reber PU, Ris HB, Hakki H, Widmer MK. Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score. Eur J Vasc Endovasc Surg. 2000 Feb; 19(2):190-6. doi: 10.1053/aves.1999.0980.
Healey CT, Neilson M, Clark D, Schanzer A, Robinson W; Vascular Study Group of New England None. Predicting mortality of ruptured abdominal aortic aneurysms in the era of endovascular repair. Ann Vasc Surg. 2017 Jan;38:59-63. doi: 10.1016/j.avsg.2016.09.006.
Davidović L, Marković M, Kostić D, Činara I, Marković D, Maksimović Ž, et al. The abdominal aortic aneurysms: factors influencing early survival. Ann Vasc Surg. 2005 Jan; 19(1):29-34. doi: 10.1007/s10016-004-0148-9.
Kawatani Y, Nakamura Y, Kurobe H, Suda Y, Hori T. Correlations of perioperative coagulopathy, fluid infusion and blood transfusions with survival prognosis in endovascular aortic repair for ruptured abdominal aortic aneurysm. World J Emerg Surg. 2016 Jun 17;11:29. doi: 10.1186/s13017-016-0087-0.
Singhal R, Coghill's, Guy A, Bradbury AW, Adam DJ, Scriven JM. Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2005 Sep; 30(3):263-6. doi: 10.1016/j.aves.2005.04.003.
Lieberg J, Pruks L-L., Kals M, Paapstel K, Aavik A, Kals J. Mortality after elective and ruptured abdominal aortic aneurysm surgical repair: 12-year single-center experience of Estonia. Scan J Surg. 2018 June; 107(2):152-7. doi: 10.1177/1457496917738923.
Biancari F, Leo E, Ylönen K, Vaarala MH, Rainio P, Juvonen T. Value of the Glasgow Aneurysm Score in predicting the immediate and long-term outcome after elective open repair of infrarenal abdominal aortic aneurysm. Br J Surg. 2003 July; 90(7):838-44. doi: 10.1002/bjs.4130.
Tambyraja AL, Murie JA, Chalmers RT. Prediction of outcome after abdominal aneurysm rupture. J Vasc Surg. 2008 Jan; 47(1):222-30. doi: 10.1016/j.jvs.2007.07.035.
