The open-first strategy is acceptable for ruptured abdominal aortic aneurysm even in the endovascular era.

Autor: Seike, Yoshimasa, Yokawa, Koki, Koizumi, Shigeki, Shinzato, Kento, Kasai, Mio, Masada, Kenta, Inoue, Yosuke, Sasaki, Hiroaki, Matsuda, Hitoshi
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Zdroj: Surgery Today; Feb2024, Vol. 54 Issue 2, p138-144, 7p
Abstrakt: Purpose: To examine the surgical findings of ruptured abdominal aortic aneurysm (RAAA) based on the open-first strategy in the last decade, and to analyze the predictors of in-hospital mortality for RAAA in the endovascular era. Methods: The subjects of this retrospective study were 116 patients who underwent RAAA repair, for whom sufficient data were available [25% female, median age 76 (70–85) years]. Sixteen (13.8%) patients were managed with endovascular aneurysm repair (EVAR) and 100 patients (86.2%) were managed with open surgical repair (OSR). Results: Univariate analysis identified base excess (BE) (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.79–0.96; p = 0.006), and preoperative cardiopulmonary arrest (CPA) [OR] 15.4; 95% [CI] 1.30–181; p = 0.030), BE (OR 0.88; 95% CI 0.79–0.96; p = 0.006), shock index (OR 2.44; 95% CI 1.01–5.94; p = 0.050), lactic acid (Lac) (OR 1.18; 95% CI 1.02–1.36; p = 0.026), and blood sugar (BS) > 215 (OR 3.46; 95% CI 1.10–10.9; p = 0.034) as positive predictors of hospital mortality. Conclusions: The findings of this study suggest that a first-line strategy of OSR for ruptured AAAs is acceptable. Poor preoperative conditions, including a high shock index, CPA, low BE, high Lac, and a BS level > 215 mg/dl, were identified as predictors of hospital mortality, rather than the procedures themselves. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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