Prehospital Treatment of Infrarenal Ruptured Abdominal Aortic Aneurysms: A Multicentric Analysis
Presented at the 23rd Annual Meeting of the French Society for Vascular Surgery, Lyon, France, June 14-18, 2008.
published online 05 January 2010.
Background
The aim of this study was to evaluate the quality of the current treatment of patients presenting with ruptured abdominal aortic aneurysms (RAAAs), from the first symptoms to the operating room with an analysis of preoperative mortality risk factors.
Methods
For 3 years, in four vascular surgery departments, we have collected all the consecutive cases of patients operated on for RAAA. We analyzed the initial clinical situation, the means of transportation, the time elapsed before treatment, and the mortality rate at 3 days. Sixty-six RAAAs were operated on. Mean patient age was 76 years (range, 52–93 years).
Results
The initial symptoms were a precisely located pain either abdominal (45.3%), lumbar (17.2%), or both (14.1%) or feeling faint (10.9%). In 22.7% of the cases, an initial hemodynamic instability was observed. In 46.8% of the cases, patients first went to a peripheral hospital before being admitted into a referral centre. In 84.5% of the cases, medical mean of transportation was used. The mean distance covered was 59.8 kilometers (range, <5 km to 213 km). The initial diagnosis was accurate in 67.3% of the cases. The mean intrahospital waiting period between the arrival at a reference center and the admission into an operating room was 127minutes. Global mortality rate was 44.2%. The main preoperative mortality factor to be noticed was the initial hemodynamic instability (p=0.0031). Among stable patients, only two of them (5.4%) worsened during the preoperative treatment.
Conclusion
In our study, hemodynamic instability corresponds to the main prognosis factor of mortality. In most cases, the initial stability persisted and allowed additional evaluation. However, the intrahospital waiting periods appeared to be too long. To be optimal, the adequate treatment should be specifically designed as soon as a diagnosis has been established.
1Service de Chirurgie Vasculaire, Hôpital Jean Minjoz, CHU de Besançon, Besançon Cedex, France
2Service de Chirurgie Vasculaire, Hôpital Robert Debré, CHU de Reims, Reims Cedex, France
3Service de Chirurgie Vasculaire, Hospices civils de Strasbourg, Strasbourg, France
4Service de Chirurgie Vasculaire, Hôpital du Bocage, CHU de Dijon, Dijon Cddex, France
Correspondence to: Simon Rinckenbach, MD, PhD, Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Besançon, 2 Boulevard Alexandre Fleming, 25030 Besançon Cedex, France.
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