Background: A ruptured abdominal aortic aneurysm (rAAA) is life-threatening. The mortality is high and emergency
surgery is vital. Endovascular (ER) and open surgical repair (OR) are alternative approaches. Although ER is
considered as first-line treatment, there are scenarios which still require OR. We report a single-centre experience
for rAAA treated by OR.
Methods: Medical records from patients with rAAA from 1 January 2005 through 31 December 2016 were
screened. We defined rAAA as retro- or intraperitoneal haemorrhage originating from the infra- or juxtarenal
aorta. We analysed the surgical approaches and report patient short-term and follow-up outcomes. Statistical
differences were examined by log rank and chi-square test.
Results: Thirty-five patients at the mean age of 73 ± 10 years (47–91) were included. Aneurysm location was
infrarenal (n = 20), juxtarenal (n = 8), and involved the iliac arteries (n = 7). OR was performed by tube (n = 26)
or bifurcation graft (n = 9) implantation. Additional vascular reconstructions were performed in 14 patients. We
observed one intra-operative oesophageal leakage. Post-operative complications included haemodialysis (n = 17),
tracheotomy (n = 15), multiple organ failure (n = 11), cardiopulmonary resuscitation (n = 5), intestinal ischaemia
(n = 5), sepsis (n = 5), stroke (n = 3) and coronary stenting (n = 2). Nine patients required early revision surgery.
There were twelve patients available for the follow-up. Thirty-day mortality was 37%, and overall mortality was
40% after 118 months. Mortality was associated with the direction of rupture, the shock index (SI) and the need for
early revision surgery (p = <0.05).
Conclusion: OR for rAAA remains valuable. In cases for which OR is warranted, the direction of rupture, SI and
need for early revision surgery were predictors for mortality.