Open Repair for Ruptured Abdominal Aortic Aneurysm: Is It Possible to Predict Survival?

Antonello, M.; Frigatti, P.; Maturi, C.; Lepidi, S.; Noventa, F.; Pittoni, G.; Deriu, G.P.; Grego, F.

doi:10.1016/j.avsg.2008.05.011

« Previous Next »Annals of Vascular Surgery
Volume 23, Issue 2 , Pages 159-166, March 2009

Open Repair for Ruptured Abdominal Aortic Aneurysm: Is It Possible to Predict Survival?

M. Antonello
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
- Correspondence to: Michele Antonello, MD, PhD, Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Via Giustiniani 2, 35100 Padua, Italy
P. Frigatti
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
C. Maturi
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
S. Lepidi
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
F. Noventa
- Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy
G. Pittoni
- Department of Anesthesiology and Reanimation, Azienda Ospedaliera di Padova, Padua, Italy
G.P. Deriu
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
F. Grego
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy

published online 01 October 2008.

The aim of the study was to determine variables that could be used to predict survival in patients with ruptured abdominal aortic aneurysm (RAAA) and to assess the accuracy of the Glasgow Aneurysm Score (GAS) and the Acute Physiology Chronic Health Evaluation II (APACHE-II). From January 1998 to July 2006, 103 patients underwent operations for RAAA. For each patient, 44 variables were retrospectively recorded in a database. Data were analyzed with univariate and multivariate methods. In the univariate analysis significant predictors of death were hypotension (p = 0.001), preexisting peripheral vascular disease (p < 0.001), renal insufficiency (p = 0.037), chronic obstructive pulmonary disease (p = 0.028), level of HCO₃^- (p < 0.001), intraperitoneal rupture (p = 0.001), blood transfused (p < 0.001), cardiac complications (p < 0.001), and APACHE-II score (p = 0.001). Multivariate analysis confirmed statistical significance for coexisting peripheral vascular disease (p < 0.001), diastolic blood pressure at admission <60 mm Hg (p = 0.039), APACHE-II score >18.5 (p = 0.025), HCO₃^- <21 mg/dL (p < 0.001), and intraperitoneal rupture of the aneurysm (p = 0.011) as predictors of death. Results of the study suggested that different factors can be helpful in identifying those patients whose operative risk is prohibitive. APACHE-II, contrary to GAS, is an accurate system to predict postoperative death after repair for RAAA.