PMID- 27395813 OWN - NLM STAT- MEDLINE DCOM- 20170123 LR - 20171112 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 36 DP - 2016 Oct TI - The Rationale for Continuing Open Repair of Ruptured Abdominal Aortic Aneurysm. PG - 64-73 LID - S0890-5096(16)30458-7 [pii] LID - 10.1016/j.avsg.2016.02.037 [doi] AB - BACKGROUND: Mortality after open repair of ruptured abdominal aortic aneurysms (RAAAs) remains high. The purpose of this study is to present the results of open RAAA treatment observing 2 different 10-year periods in a single high-volume center and to consider the possibilities of result improvement in the future. METHODS: Retrospective analysis of 729 RAAA patients who were treated through 1991-2001 (229 patients, Group A) and 2002-2011 (500 patients, Group B) was performed. Variables significantly associated with mortality were defined and analyzed. RESULTS: Overall 30-day mortality in Group A was 53.7% (123/229 patients) with intraoperative mortality of 13.5% (31/229 patients), while in Group B it was 37.4% (187/500 patients) with intraoperative mortality of 12.4% (62/500 patients). Overall 30-day mortality was significantly lower in Group B (P = 0.012). There was no difference regarding intraoperative mortality (P = 0.797). Preoperative severe hemodynamic instability (P < 0.01, P < 0.001), cardiac arrest (P < 0.01, P < 0.001), consciousness deterioration (P < 0.05, P < 0.001), renal malfunction (P < 0.01, P < 0.001), and significant anemia (P < 0.01, P < 0.001) were associated with increased mortality in both A and B groups, respectively. Aortic cross-clamping level in Group A was predominantly infrarenal (68%) while in Group B it was mostly supraceliac (53%) (P < 0.001). Cross-clamping time, duration of surgery, and type of aortic reconstruction had no influence on survival in Group B (P > 0.05). Intraoperative hemodynamic instability (P < 0.01, P < 0.001), significant bleeding (P < 0.05, P < 0.01), and low urine output (P < 0.05, P < 0.001) remained parameters that favored lethal outcome in both A and B groups, respectively. Cell saving was used only in Group B. The multivariate logistic regression applied on the complete sample of patients presented several significant predictors of lethal outcome: congestive heart failure on admission (odds ratio [OR] 1.954, 95% confidence interval [CI] 1.103-3.460), intraperitoneal rupture (OR 3.009, 95% CI 1.771-5.423), aortofemoral reconstruction (OR 1.928, 95% CI 1.044-3.563), and total operative time (OR 1.005, 95% CI 1.001-1.010). Postoperative multisystem organ failure (P < 0.01, P < 0.001), respiratory (P < 0.01, P < 0.001) and renal (P < 0.05, P < 0.001) failure, postoperative bleeding (P < 0.05), and cerebrovascular incidents (P < 0.05, P < 0.01) significantly increased mortality in both A and B groups. CONCLUSIONS: Although unselective, aggressive surgical approach in RAAA performed by teams experienced in open repair can improve patient's survival. Short admission/surgery time, supraceliac aortic cross-clamping, and the use of intraoperative cell saving are recommended. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Markovic, Miroslav AU - Markovic M AD - Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. Electronic address: drmiroslav@gmail.com. FAU - Tomic, Ivan AU - Tomic I AD - Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. FAU - Ilic, Nikola AU - Ilic N AD - Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. FAU - Dragas, Marko AU - Dragas M AD - Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. FAU - Koncar, Igor AU - Koncar I AD - Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. FAU - Bukumiric, Zoran AU - Bukumiric Z AD - Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute for Medical Statistics and Informatics, Faculty of Medicine, Belgrade, Serbia. FAU - Sladojevic, Milos AU - Sladojevic M AD - Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. FAU - Davidovic, Lazar AU - Davidovic L AD - Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. LA - eng PT - Comparative Study PT - Journal Article DEP - 20160706 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 SB - IM MH - Aged MH - Aortic Aneurysm, Abdominal/diagnostic imaging/mortality/*surgery MH - Aortic Rupture/diagnostic imaging/mortality/*surgery MH - *Blood Vessel Prosthesis Implantation/adverse effects/mortality MH - Chi-Square Distribution MH - Constriction MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Hospital Mortality MH - Hospitals, High-Volume MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Odds Ratio MH - Operative Blood Salvage MH - Operative Time MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Serbia MH - Time Factors MH - Treatment Outcome EDAT- 2016/07/11 06:00 MHDA- 2017/01/24 06:00 CRDT- 2016/07/11 06:00 PHST- 2015/12/11 00:00 [received] PHST- 2016/02/07 00:00 [revised] PHST- 2016/02/25 00:00 [accepted] PHST- 2016/07/11 06:00 [pubmed] PHST- 2017/01/24 06:00 [medline] PHST- 2016/07/11 06:00 [entrez] AID - S0890-5096(16)30458-7 [pii] AID - 10.1016/j.avsg.2016.02.037 [doi] PST - ppublish SO - Ann Vasc Surg. 2016 Oct;36:64-73. doi: 10.1016/j.avsg.2016.02.037. Epub 2016 Jul 6.