Abstract
In Japan, surgical treatment for abdominal aortic aneurysm (AAA) is generally performed
in hospitals with specialized vascular surgeons, thus necessitating transportation
of patients. Transportation of patients with ruptured AAA sometimes results in irreversible
hypotension and death. In our hospital, a program of “on site” surgery for patients
with ruptured AAA was initiated, in which vascular surgeons went to the hospitals
where ruptured AAA patients were initially admitted instead of transporting the patients.
Twenty-nine patients with ruptured AAA were included in this study. Prior to October
1995, 22 of these patients were transported to our hospital (transport group). After
October 1995, seven patients received on site surgery performed by our team (on site
group). The mean age of patients in the transport and on site group was 68 ± 10 and
70 ± 11 years old, respectively. In the transport group, graft replacement was performed
in 16 patients, aorto-femoral bypass in one, axillo-femoral bypass in one, and laparotomy
only in four in whom aortic reconstruction was impossible due to cardiac arrest. The
time between the patient diagnosis and operation in the on site group was 64 ± 21
min, which was shorter than the time of 127 ± 23 min in the transport group. In the
on site group, graft replacement was performed in all seven patients. Operative and
hospital mortality of the transport and on site group were 13/22 (59%) and 1/7 (14%),
respectively. In the on site group, only one patient died of preoperative small intestinal
perforation and septic shock. The incidence of postoperative morbidity was significantly
higher in the transport group than in the on site group, which accounted for the large
differences in mortality. In conclusion, we have received good operative results of
on site surgery for ruptured AAA in this initial study. However, this study is not
randomized and the number of patients is small. Thus, further studies with larger
number of patients are needed to determine if on site surgery is the treatment of
choice for patients with ruptured AAA.
