On site surgical treatment of ruptured abdominal aortic aneurysm

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.