Race Over Time in Ruptured Abdominal Aortic Aneurysm: A Retrospective Analysis of Survival and Treatment Outcomes

Öz

Aim: Ruptured abdominal aortic aneurysms (rAAA) are a surgical emergency with high pre- and postoperative mortality. The aim of this study was to investigate the factors affecting preoperative, intraoperative and postoperative mortality in infrarenal abdominal aortic aneurysms treated with emergency surgery. Material and Methods: Thirty-eight patients [male 34 (89.4%), female 4 (10.6%)] who underwent emergency and open surgery for ruptured abdominal aortic aneurysm between 2019 and 2024 were included in the study. Preoperative and postoperative demographic characteristics of the patients were retrospectively analyzed. Patients were divided into two groups according to the hospitals visited for treatment after the onset of symptoms. Patients admitted to our emergency department or brought by ambulance were divided into Group-1 (n=17) and patients diagnosed from external centers and consulted to us were divided into Group-2 (n=21). Results: The mean age of the 38 patients included in the study was 63.57 ± 13.62 years. 34 of the patients were male (89.4%) and four were female (10.6%). Concomitant risk factors were chronic obstructive pulmonary disease (n=17, 50%), diabetes (n=25, 65.7%), hypertension (n=33, 86.8%), hyperlipidemia (n=35, 92.1%) and acute renal failure (n=4, 10.5%). A total of 9 (23.6%) patients died. All mortal patients died during intensive care unit follow-up (10 ± 9.6 days). Since our hospital is located in the region, mortality was higher in patients referred from neighboring provinces. Of the nine patients, seven were referred after being diagnosed in an external center. The causes of mortality were renal failure, multiorgan failure, respiratory distress syndrome and sepsis. Conclusion: When patients presenting to the emergency department with abdominal pain are operated as soon as possible after the diagnosis of rAAA, there is a significant reduction in motrality rates. Hypotension, high urea and creatinine levels, blood loss, inadequate blood and fluid administration, loss of consciousness, cardiac arrest are the causes of increased preoperative mortality. Short duration of aortic cross-clamping, minimizing intraoperative blood loss, protecting patients from low blood pressure during the operation and good diuresis increase the survival rate.

Anahtar Kelimeler

• Ruptured abdominal aortic aneurysms
• mortality
• time

Rüptüre Abdominal Aort Anevrizmasında Zamanla Yarış: Hayatta Kalma ve Tedavi Sonuçlarının Retrospektif Analizi

Öz

Amaç: Rüptüre abdominal aort anevrizmaları (rAAA) operasyon öncesi ve sonrası yüksek mortaliteye sahip acil cerrahi bir durumdur. Bu çalışmanın amacı acil cerrahi tedavi edilen infrarenal abdominal aort anevrizmalarında operasyon öncesi, sırası ve sonrası mortaliteye etki eden faktörlerin araştırılmasıdır Gereç ve Yöntemler: Abdominal aort anevrizma rüptürü tanısı ile 2019-2024 yılları arasında acil ve açık cerrahi ile opere edilen 38 hasta [erkek 34(%89,4), kadın 4(%10,6)] çalışmaya alınmıştır. Hastaların operasyon öncesi ve operasyon sonrası demografik özellikleri retrospektif olarak incelenmiştir. Semptomların başlamasından sonra tedavi amaçlı gidilen hastanelere göre hastalar iki gruba ayrıldı. Acil servisimize başvuran veya ambulans ile getirilen hastalar Grup-1 (n=17) ve dış merkezlerden tanı konulup tarafımıza refere edilen hastalar Grup-2 (n=21) olarak ayrıldılar. Bulgular: Çalışmaya alınan 38 hastanın yaş ortalaması 63,57 ± 13,62 yıldı. Hastaların 34’ü erkek ve dördü kadındı. Eşlik eden risk faktörleri kronik obstrüktif akciğer hastalığı (n=17, %50), diyabet (n=25, %65,7), hipertansiyon (n=33, %86,8), hiperlipidemi (n=35, %92,1) ve akut böbrek yetersizliği (n=4, %10,5) idi. Toplam 9 (%23,6) hasta kaybedildi. Mortal seyreden hastaların hepsi yoğun bakım takipleri sırasında (10 ± 9,6 gün) kaybedildi. Hastanemiz bölgeye hitap etmesi nedeniyle çevre illerden sevk edilen hastalarda mortalite daha yüksek görüldü. Dokuz hastanın yedisi dış merkezde tanı konularak sevk edilen hastalardı. Mortalite sebepleri renal yetersizlik, multiorgan yetersizliği, respiratuvar distrest sendromu ve sepsis olarak görüldü. Sonuç: Karın ağrısı nedeniyle acil servise başvuran hastaların rAAA tanısı konulduktan sonra mümkün olan en kısa sürede opere edildiğinde ölüm oranlarında önemli oranda azalma görülmektedir. Hipotansiyon, yüksek üre ve kreatinin seviyeleri, kan kaybı, yetersiz kan ve mayi verilmesi, bilinç kaybı, kardiyak arrest operasyon öncesi mortaliteyi arttırıcı nedenlerdir. Kısa süren aortik kross klemp süresi, intraoperatif kan kaybının minimum seviyeye indirilmesi, hastaları operasyon sırasında düşük tansiyondan korumak ve iyi bir diürez ile sağ kalım oranı yükselmektedir.

Anahtar Kelimeler

• Rüptüre abdominal aort anevrizmaları
• mortalite
• zaman

Kaynakça

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